Relationship between arm morbidity and patient-reported outcomes following surgery in women with node-negative breast cancer: NSABP protocol B-32.
Relationship between arm morbidity and patient-reported outcomes following surgery in women with node-negative breast cancer: NSABP protocol B-32.
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淋巴结阴性乳腺癌女性手术后手臂发病率与患者报告结果之间的关系：NSABP 方案 B-32。
DOI：
10.1016/j.suponc.2012.05.003
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Ganz,PatriciaA
中科院分区：
文献类型：
--
作者：
Kopec,JacekA;Colangelo,LindaH;Land,StephanieR;Julian,ThomasB;Brown,AnnM;Anderson,StewartJ;Krag,DavidN;Ashikaga,Takamaru;Costatino,JosephP;Wolmark,Norman;Ganz,PatriciaA
背景乳腺癌术后手臂并发症对患者观察到的日常功能改变和健康相关生活质量(HRQOL)的影响尚未得到很好的研究。目的探讨客观测量指标如活动度(ROM)和淋巴水肿与患者报告的手臂和乳房预后(PRO)、上肢功能、活动度和HRQL的关系。方法国家外科辅助乳肠计划B-32是一项随机试验，比较前哨淋巴结清扫术(SNR)和腋窝清扫术(AD)对淋巴结阴性乳腺癌患者的疗效。客观测量ROM和上臂体积。优点包括症状；手臂功能；社交、娱乐、职业和其他常规活动的限制；以及全球HRQL指数。统计学方法包括交叉表格法和多元线性回归模型。结果总共有744名女性提供了至少一项术后评估。大约三分之一的患者手臂活动受限。同样数量的患者在手术后6个月避免使用手臂。约四分之一的患者报告在工作和其他常规活动方面受到限制。在这项多变量分析中，手臂活动度和感觉神经病是患者报告的手臂功能和总体HRQL的预测因子。活动受限的预测因素还包括手术侧(显性与非显性)。经感觉神经病变和关节活动度调整后，水肿不明显。仅在随访期间(6个月)同时测量一次肢体活动度和水肿度。结论：乳腺癌术后感觉神经病和手臂活动受限的临床测量与自我报告的活动受限和总体HRQL的降低有关。
Background The impact of arm morbidity following breast cancer surgery on patient-observed changes in daily functioning and health-related quality of life (HRQoL) have not been well-studied. Objective To examine the association of objective measures such as range of motion (ROM) and lymphedema, with patient-reported outcomes (PROs) in the arm and breast, upper extremity function, activities, and HRQoL. Methods The National Surgical Adjuvant Breast and Bowel Project Protocol B-32 was a randomized trial comparing sentinel node resection (SNR) with axillary dissection (AD) in women with node-negative breast cancer. ROM and arm volume were measured objectively. PROs included symptoms; arm function; limitations in social, recreational, occupational, and other regular activities; and a global index of HRQoL. Statistical methods included cross-tabulations and multivariable linear regression models. Results In all, 744 women provided at least 1 postsurgery assessment. About one-third of the patients experienced arm mobility restrictions. A similar number of patients avoided the use of the arm 6 months after surgery. Limitations in work and other regular activities were reported by about a quarter of the patients. In this multivariable analysis, arm mobility and sensory neuropathy were predictors of patient-reported arm function and overall HRQoL. Predictors for activity limitations also included side of surgery (dominant vs nondominant). Edema was not significant after adjustment for sensory neuropathy and ROM. Limitations Arm mobility and edema were measured simultaneously only once during the follow-up (6 months). Conclusion Clinical measures of sensory neuropathy and restrictions in arm mobility following breast cancer surgery are associated with self-reported limitations in activity and reductions in overall HRQoL.
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