Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up
Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up
复制标题
DOI：
10.1016/j.breast.2017.09.006
复制
发表时间：
2017-12-01
期刊：
影响因子：
3.9
通讯作者：
Bergmann, Anke
中科院分区：
文献类型：
--
作者：
Padula Ribeiro Pereira, Ana Carolina;Koifman, Rosalina Jorge;Bergmann, Anke
目的：评估乳腺癌手术治疗后10年内水肿的发病率和危险因素。方法：前瞻性观察医院队列接受腋窝淋巴结清扫术的妇女。通过间接体积评估淋巴水肿，通过周长测量，如果两组之间的差异200 mL或患者是否接受治疗，则诊断为淋巴水肿。自变量为患者，肿瘤和治疗特征。使用Kaplan-Meier估计值进行描述性统计作为生存分析。进行考克斯回归，考虑95%置信区间（95%CI）。随访2年时观察到的水肿累积发生率为13.5%，5年时为30.2%，10年时为41.1%。最终模型显示接受放疗的女性患淋巴水肿的风险增加（HR = 2.19; 95% CI 1.63-.94），肥胖（HR = 1.52; 95% CI 1.20-1.92），术后有血清肿形成（HR = 1.46; 95% CI 1.14-1.87），患肢接受化疗输注（HR = 1.45; 95% CI 1.12-1.87）或晚期疾病分期（HR = 1.41; 95% CI 1.11-1.80）。接受腋窝放疗、肥胖、发生血清肿、患肢接受化疗和晚期疾病的女性发生水肿的风险更高。(C)2017爱思唯尔有限公司出版
Purpose: To evaluate the incidence and risk factors of lymphedema 10 years after surgical treatment for breast cancer.Methods: Prospective observational hospital-based cohort of women undergoing axillary lymph node dissection. Lymphedema was assessed by indirect volume, measured by circumference, and diagnosed if there was a difference of 200 mL between the arms or if the patient was treated for it. Independent variables were patient, tumour and treatment characteristics. Descriptive statistics were conducted as survival analysis using the Kaplan-Meier estimate. Cox regression was performed, considering a 95% confidence interval (95%CI).Results: The study evaluated 964 women. The cumulative incidence of lymphedema observed was 13.5% at two years of follow-up, 30.2% at five years and 41.1% at 10 years. Final model showed an increased risk for lymphedema among women that underwent radiotherapy (HR = 2.19; 95% CI 1.63-.94), were obese (HR = 1.52; 95% CI 1.20-1.92), had seroma formation after surgery (HR = 1.46; 95% CI 1.14-1.87), underwent chemotherapy infusion in the affected limb (HR = 1.45; 95% CI 1.12-1.87) or advanced disease staging (HR = 1.41; 95% CI 1.11-1.80).Conclusions: Cumulative incidence of lymphedema was 41.1%. Women undergoing axillary radiotherapy, obese, who developed seroma, underwent chemotherapy infusion in the affected limb and with advanced disease had a higher risk of lymphedema. (C) 2017 Published by Elsevier Ltd.