Predictors of Lymphedema in Patients With Breast Cancer Undergoing Axillary Lymph Node Dissection in Hong Kong
Predictors of Lymphedema in Patients With Breast Cancer Undergoing Axillary Lymph Node Dissection in Hong Kong
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DOI：
10.1097/nnr.0b013e31818c3de2
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发表时间：
2008-11-01
期刊：
影响因子：
2.5
通讯作者：
Kwan, Wing Hong
中科院分区：
文献类型：
--
作者：
Mak, So Shan;Yeo, Winnie;Kwan, Wing Hong
背景。在香港，乳腺癌的发病率正在迅速上升。淋巴水肿是乳腺癌手术和放射治疗的严重长期并发症。目的：本研究的目的是评估接受过腋窝淋巴结清扫术的乳腺癌患者发生淋巴水肿的危险因素，并探讨与中重度淋巴水肿相关的潜在因素。方法：这是一项匹配的病例对照研究，对象为 202 名接受单侧腋窝淋巴结清扫术的女性。 对于乳腺癌，由 101 例淋巴水肿病例和 101 例对照组成，这些对照在手术日期、腋窝放疗和癌症分期方面与病例相匹配。测量臂围以确定淋巴水肿的存在和严重程度。通过临床数据和问卷调查收集潜在的危险因素。使用多重逻辑回归来获得发生淋巴水肿的潜在危险因素的调整优势比。还进行了探索性分析，以确定与中度至重度淋巴水肿发生相关的因素。结果：对于既往炎症感染，发生淋巴水肿的调整比值比为 3.80（95% 置信区间 [CI] 1.84-7.87），对于腋窝淋巴结清扫时年龄增加 1 岁，发生淋巴水肿的调整比值比为 1.06（95% CI = 1.02-1.10）。在探索性分析中，对于既往炎症感染，中度至重度淋巴水肿的调整后比值比为 4.53 (95% CI = 2.16-9.52)，对于优势臂手术为 2.94 (95% CI = 1.44-6.03)，对于体重指数增加 I kg/m(2) 为 1.11 (95% CI = 1.01-1.22)。 （体重指数）于 招募时年龄增加 1 岁，则为 1.05 (95% CI = 1.01-1.10)。讨论：既往炎症感染和腋窝淋巴结清扫时的高龄是与淋巴水肿发生相关的危险因素。既往炎症感染、惯用手一侧手术、肥胖和衰老是淋巴水肿加重的潜在危险因素。即使在 BMI 较低的人群中，较高的 BMI 仍然是淋巴水肿进展的危险因素。
Background. The incidence rate of breast cancer is rising rapidly in Hong Kong. Lymphedema is a serious long-term complication of breast cancer surgery and radiation therapy.Objective: The objectives of this study were to evaluate risk factors associated with the development of lymphedema for patients with breast cancer who have had an axillary lymph node dissection and to explore potential factors associated with moderate to severe lymphedema.Methods: This was a matched case-control study of 202 women undergoing a unilateral axillary dissection for breast cancer, consisting of 101 cases with lymphedema and 101 controls who matched cases in terms of surgery date, axillary radiotherapy, and cancer stage. Arm circumferences were measured to determine presence and severity of lymphedema. Potential risk factors were collected by using clinical data and a questionnaire. A multiple logistic regression was used to obtain the adjusted odds ratios for potential risk factors for developing lymphedema. Exploratory analysis was also performed to identify factors associated with the development of moderate to severe lymphedema.Results: Adjusted odds ratios for the development of lymphedema were 3.80 (95% confidence interval [CI] 1.84-7.87) for previous inflammation-infection and 1.06 (95% CI = 1.02-1.10) for an increase of 1 year of age at axillary dissection. On exploratory analysis, adjusted odds ratios for moderate to severe degree of lymphedema were 4.53 (95% CI = 2.16-9.52) for previous inflammation-infection, 2.94 (95% CI = 1.44-6.03) for operation on dominant arm, 1.11 (95% CI 1.01-1.22) for an increase of I kg/m(2) in body mass index (BMI) at recruitment, and 1.05 (95% CI = 1.01-1.10) for an increase of 1 year of age at recruitment time.Discussion: Previous inflammation-infection and advanced age at axillary dissection are risk factors associated with the initiation of lymphedema. Previous inflammation-infection, operation on the side of the dominant hand, obesity, and aging are potential risk factors associated with the aggravation of lymphedema. Greater BMI is still a risk factor for lymphedema progression even in a lower BMI population.