Objective To identify the incidence and risk factors for upper extremity lymphedema within 2 years after surgery in patients with breast cancer. Methods A follow-up study was performed among 157 patients who newly received surgical treatment for breast cancer. Norman questionnaire and circumference measurement were used to evaluate the volume of the upper limb before treatment and at 1, 3, 6, 12, 18, and 24 months after treatment. The incidence of lymphedema was calculated. Based on the results of circumference measurement, the log-rank test and Cox regression were used to analyze the risk factors for lymphedema. Results A total of 141 patients were finally enrolled as subjects. The incidence rates of lymphedema at 1, 3, 6, 12, 18, and 24 months after surgery were 3.5%, 9.2%, 13.5%, 24.8%, 28.4%, and 30.5% by Norman questionnaire, and 1.4%, 3.5%, 9.2%, 20.6%, 27.0%, and 27.7% by circumference measurement. At 24 months after surgery, 31(22.0%) out of 39 patients with lymphedema had mild lymphedema. Axillary lymph node dissection (ALND), radiotherapy, modified radical mastectomy (MRM), and the number of removed axillary lymph nodes were independent risk factors for lymphedema (HR=13.58, 95% CI:2.17-85.00;HR=3.54, 95% CI:1.13-11.07;HR=2.19, 95% CI:1.07-4.49;HR=1.11, 95% CI:1.05-1.16). Conclusions The incidence of lymphedema associated with breast cancer increases gradually within 2 years after surgery, especially fast in the first year. ALND, radiotherapy, MRM, and the number of removed axillary lymph nodes are independent risk factors for lymphedema.
Liu Fenghua,Hu Yan,Shen Peipei et al. Lymphedema after surgical treatment for breast cancer:a 2-year follow-up study of incidence and risk factors[J]. Chinese Journal of Radiation Oncology, 2016, 25(6): 593-597.
[1] McLaughlin SA,Bagaria S,Gibson T,et al. Trends in risk reduction practices for the prevention of lymphedema in the first 12 Months after breast cancer surgery[J].J Am Coll Surg,2013,216(3):380-389.DOI:10.1016/j.jamcollsurg.2012.11.004. [2] Fu MR,Ridner SH,Hu SH,et al. Psychosocial impact of lymphedema:a systematic review of literature from 2004 to 2011[J].Psycho-Oncology,2013,22(7):1466-1484.DOI:10.1002/pon.3201. [3] Fu MR,Kang Y.Psychosocial impact of living with cancer-related lymphedema[J].Semin Oncol Nurs,2013,29(1):50-60.DOI:10.1016/j.soncn.2012.11.007. [4] Han JW,Seo YJ,Choi JE,et al. The efficacy of arm node preserving surgery using axillary reverse mapping for preventing lymphedema in patients with breast cancer[J].J Breast Cancer,2012,15(1):91-97.DOI:10.4048/jbc.2012.15.1.91. [5] Armer JM,Stewart BR.Post-breast cancer lymphedema:incidence increases from 12 to 30 to 60 months[J].Lymphology,2010,43(3):118-127. [6] Norman SA,Localio AR,Kallan MJ,et al. Risk factors for lymphedema after breast cancer treatment[J].Cancer Epidemiol Biomarkers Prev,2010,19(11):2734-2746.DOI:10.1158/1055-9965.EPI-09-1245. [7] Deutsch M,Land S,Begovic M,et al. The incidence of arm edema in women with breast cancer randomized on the National Surgical Adjuvant Breast and Bowel Project study B-04 to radical mastectomy versus total mastectomy and radiotherapy versus total mastectomy alone[J].Int J Radiat Oncol Biol Phys,2008,70(4):1020-1024.DOI:10.1016/j.ijrobp.2007.07.2376. [8] Asim M,Cham A,Banerjee S,et al. Difficulties with defining lymphoedema after axillary dissection for breast cancer[J].N Z Med J,2012,125(1351):29-39. [9] Pavy JJ,Denekamp J,Letschert J,et al. Late effects toxicity scoring:the SOMA scale[J].Radiother Oncol,1995,35(1):11-15.DOI:10.1016/0167-8140(95)97448-M. [10] Czerniec SA,Ward LC,Refshauge KM,et al. Assessment of breast cancer-related arm lymphedema-comparison of physical measurement methods and self-report[J].Cancer Invest,2010,28(1):54-62.DOI:10.3109/07357900902918494. [11] Armer JM,Stewart BR.A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population[J].Lymphat Res Biol,2005,3(4):208-217.DOI:10.1089/lrb.2005.3.208. [12] Hayes S,Sipio TD,Rye S,et al. Prevalence and prognostic significance of secondary lymphedema following breast cancer[J].Lymphat Res Biol,2011,9(3):135-141.DOI:10.1089/lrb.2011.0007. [13] Hayes S,Janda M,Cornish B,et al. Lymphedema secondary to breast cancer:how choice of measure influences diagnosis,prevalence,and identifiable risk factors[J].Lymphology,2008,41(1):18-28. [14] Lopez Penha TR,Slangen JJ,Heuts EM,et al. Prevalence of lymphoedema more than five years after breast cancer treatment[J].Eur J Surg Oncol,2011,37(12):1059-1063.DOI:10.1016/j.ejso.2011.09.001. [15] DiSipio T,Rye S,Newman B,et al. Incidence of unilateral arm lymphoedema after breast cancer:a systematic review and meta-analysis[J].Lancet Oncol,2013,14(6):500-515.DOI:10.1016/S1470-2045(13)70076-7. [16] Norman SA,Localio AR,Potashnik SL,et al. Lymphedema in breast cancer survivors:incidence,degree,time course,treatment,and symptoms[J].J Clin Oncol,2009,27(3):390-7.DOI:10.1200/JCO.2008.17.9291. [17] Paskett ED,Naughton MJ,McCoy TP,et al. The epidemiology of arm and hand swelling in premenopausal breast cancer survivors[J].Cancer Epidemiol Biomarkers Prev,2007,16(4):775-782.DOI:10.1158/1055-9965.EPI-06-0168. [18] Lucci A,McCall LM,Beitsch PD,et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011[J].J Clin Oncol,2007,25(24):3657-3663.DOI:10.1200/JCO.2006.07.4062. [19] Nesvold IL,Dahl AA,Lkkevik E,et al. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy[J].Acta Oncol,2008,47(5):835-842.DOI:10.1080/02841860801961257. [20] Giuliano AE,Hunt KK,Ballman KV,et al. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis:a randomized clinical trial[J].JAMA,2011,305(6):569-575.DOI:10.1001/jama.2011.90. [21] Warren LEG,Miller CL,Horick N,et al. The impact of radiation therapy on the risk of lymphedema after treatment for breast cancer:a prospective cohort study[J].Int J Radiat Oncol Biol Phys,2014,88(3):565-571.DOI:10.1016/j.ijrobp.2013.11.232. [22] Crosby MA,Card A,Liu J,et al. Immediate breast reconstruction and lymphedema incidence[J].Plast Reconstr Surg,2012,129(5):789e-795e. DOI:10.1097/PRS.0b013e31824a2ab1. [23] Grtner R,Jensen MB,Kronborg L,et al. Self-reported arm-lymphedema and functional impairment after breast cancer treatment–a nationwide study of prevalence and associated factors[J].Breast,2010,19(6):506-515.DOI:10.1016/j.breast.2010.05.015. [24] Zhu YQ,Xie YH,Liu FH,et al. Systemic analysis on risk factors for breast cancer related lymphedema[J].Asian Pac J Cancer Prev,2014,15(16):6535-6541.DOI:10.7314/APJCP.2014.15.16.6535. [25] Geller BM,Vacek PM,O′Brien P,et al. Factors associated with arm swelling after breast cancer surgery[J].J Womens Health,2003,12(9):921-930.DOI:10.1089/154099903770948159.
2016, Vol. 25 
