Lymphedema in Breast Cancer Survivors: Incidence, Degree, Time Course, Treatment, and Symptoms
Lymphedema in Breast Cancer Survivors: Incidence, Degree, Time Course, Treatment, and Symptoms
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DOI：
10.1200/jco.2008.17.9291
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发表时间：
2009-01-20
影响因子：
45.3
通讯作者：
Solin, Lawrence J.
中科院分区：
文献类型：
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作者：
Norman, Sandra A.;Localio, A. Russell;Solin, Lawrence J.
目的了解乳腺癌存活者淋巴水肿的发生率、程度、病程、治疗和症状。方法我们对1999年至2001年被诊断为乳腺癌的费城和特拉华县的631名女性居民进行了为期5年的基于人群的前瞻性研究。使用先前根据物理治疗师基于测量的临床标准验证的问卷，我们根据受试者感觉到的手/臂大小的差异，为每个月的随访分配了一个分数，指示淋巴水肿的程度(无、轻度或中度/重度)。标准生存分析方法允许最大限度地使用随访。结果淋巴水肿的五年累积发生率为每100名妇女42例(42%)。在238名受影响的妇女中，80%的人在确诊后2年内首次出现淋巴水肿，89%的人在3年内首次出现淋巴水肿。在观察了3年的433名妇女中，23%的人报告不超过轻度淋巴水肿，12%的人报告中度/重度淋巴水肿，2%的人报告慢性中度/重度淋巴水肿。有轻度淋巴水肿者患中度/重度淋巴水肿者的可能性是无淋巴水肿者的三倍以上。37%患有轻度淋巴水肿的女性和68%患有中度/重度淋巴水肿的女性接受了治疗。淋巴水肿程度增加的妇女报告症状的比例越来越高(例如，珠宝太紧，疲惫/粗大/重臂)。首次发生淋巴水肿前的症状与以后发生淋巴水肿的概率较高(例如，珠宝太紧的风险比=7.37；95%可信区间为4.26~12.76)。自我报告的手/臂大小和症状的细微差异可能是淋巴水肿进展的早期迹象。
PurposeTo examine the incidence, degree, time course, treatment, and symptoms of lymphedema in breast cancer survivors.MethodsWe conducted a 5-year, population-based prospective study of 631 randomly selected Philadelphia and Delaware County, Pennsylvania female residents with incident breast cancer who were diagnosed from 1999 to 2001. Using a questionnaire previously validated against physical therapists' measurement-based clinical criteria, we assigned a score indicating the degree of lymphedema (none, mild, or moderate/severe) to each month of follow-up based on the respondent's perceived differences in hand/arm size. Standard survival analysis methods permitted maximum use of follow-up.ResultsFive-year cumulative incidence of lymphedema was 42 (42%) per 100 women. Among the 238 affected women, lymphedema first occurred within 2 years of diagnosis in 80% and within 3 years in 89%. Among 433 women observed for 3 years, 23% reported no more than mild lymphedema, 12% reported moderate/ severe lymphedema, and 2% reported chronically moderate/ severe lymphedema. Women with mild lymphedema were more than three times more likely to develop moderate/ severe lymphedema than women with no lymphedema. Thirty-seven percent of women with mild lymphedema and 68% with moderate/severe lymphedema received treatment. Increasing proportions of women with increasing degree of lymphedema reported symptoms (eg, jewelry too tight, tired/thick/heavy arm). Symptoms present before the first occurrence of lymphedema were associated with a higher probability of later lymphedema (eg, hazard ratio for jewelry too tight = 7.37; 95% CI, 4.26 to 12.76).ConclusionLymphedema after breast cancer is common but mostly mild. Subtle differences in self-reported hand/arm size and symptoms can be early signs of progressing lymphedema.