Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Objective Measurements
Prevalence of Lymphedema in Women With Breast Cancer 5 Years After Sentinel Lymph Node Biopsy or Axillary Dissection: Objective Measurements
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DOI：
10.1200/jco.2008.16.3725
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发表时间：
2008-11-10
影响因子：
45.3
通讯作者：
Van Zee, Kimberly J.
中科院分区：
文献类型：
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作者：
McLaughlin, Sarah A.;Wright, Mary J.;Van Zee, Kimberly J.
目的采用前哨淋巴结活检对乳腺癌患者腋窝进行分期，假设减少患者发生水肿的风险。本研究的目的是确定SLN活检（SLNB）单独和SLNB后腋窝淋巴结清扫术（SLNB/ALND）后水肿的长期患病率。患者和MethodsAt中位随访5年，936例临床淋巴结阴性乳腺癌妇女接受SLNB单独或SLNB/ALND后水肿进行了评估。基线和随访时的标准化同侧和对侧测量用于确定同侧上肢周长的变化，并控制基线不对称和体重变化。水肿和潜在的危险因素之间的关联examined.ResultsOf 936名妇女，600名妇女（64%）进行SLNB单独和336名妇女（36%）进行SLNB/ALND。单纯SLNB患者年龄大于SLNB/ALND患者（56 v52岁; P <0.0001）。两组的基线体重指数（BMI）相似。臂围测量显示，单纯SLNB患者中有5%出现水肿，而SLNB/ALND患者中有16%出现水肿（P <0.0001）。与测量的水肿相关的危险因素是更大的体重（P < .0001），更高的BMI（P < .0001），和感染（P < .0001）或损伤（P = .02）在同侧armsinsurgical.ConclusionWhen相比SLNB/ALND，SLNB单独的结果在术后5年的水肿率显着降低。然而，即使在单独SLNB后，仍然存在临床相关的水肿风险。较高的体重、感染和损伤是发生水肿的重要危险因素。
PurposeSentinel lymph node biopsy was adopted for the staging of the axilla with the assumption that it would reduce the risk of lymphedema in women with breast cancer. The aim of this study was to determine the long-term prevalence of lymphedema after SLN biopsy (SLNB) alone and after SLNB followed by axillary lymph node dissection (SLNB/ALND).Patients and MethodsAt median follow-up of 5 years, lymphedema was assessed in 936 women with clinically node-negative breast cancer who underwent SLNB alone or SLNB/ALND. Standardized ipsilateral and contralateral measurements at baseline and follow-up were used to determine change in ipsilateral upper extremity circumference and to control for baseline asymmetry and weight change. Associations between lymphedema and potential risk factors were examined.ResultsOf the 936 women, 600 women (64%) underwent SLNB alone and 336 women (36%) underwent SLNB/ALND. Patients having SLNB alone were older than those having SLNB/ALND (56 v 52 years; P < .0001). Baseline body mass index (BMI) was similar in both groups. Arm circumference measurements documented lymphedema in 5% of SLNB alone patients, compared with 16% of SLNB/ALND patients (P < .0001). Risk factors associated with measured lymphedema were greater body weight (P < .0001), higher BMI (P < .0001), and infection (P < .0001) or injury (P = .02) in the ipsilateral arm since surgery.ConclusionWhen compared with SLNB/ALND, SLNB alone results in a significantly lower rate of lymphedema 5 years postoperatively. However, even after SLNB alone, there remains a clinically relevant risk of lymphedema. Higher body weight, infection, and injury are significant risk factors for developing lymphedema.