乳腺癌相关淋巴水肿发病情况及危险因素前瞻性队列研究

目的 明确乳腺癌患者术后2年内上肢淋巴水肿的发病率及其危险因素。方法 对157例初诊手术治疗的乳腺癌患者进行随访,采用诺曼问卷和周径测量法分别在术前和术后1、3、6、12、18、24个月评估患者上肢体积变化情况,计算淋巴水肿发病率。并以周径测量法结果为基础行Logrank单因素分析和Cox模型多因素分析。结果 有效数据141例,术后1、3、6、12、18、24个月诺曼问卷调查的发病率分别为3.5%、9.2%、13.5%、24.8%、28.4%、30.5%,周径测量法结果为1.4%、3.5%、9.2%、20.6%、27.0%、27.7%。术后24个月39例淋巴水肿患者中31例为轻度水肿。腋窝淋巴结清扫(HR=13.58,95% CI∶2.17~85.00)、放疗(HR=3.54,95% CI∶1.13~11.07)、改良根治术(HR=2.19,95% CI∶1.07~4.49)、腋窝淋巴结清扫数目(HR=1.11,95% CI∶1.05~1.16)是危险因素。结论 乳腺癌相关淋巴水肿在术后2年内发病率逐渐上升,尤以第1年为甚。腋窝淋巴结清扫、放疗、改良根治术和腋窝淋巴结清扫数目为危险因素。

Lymphedema after surgical treatment for breast cancer: a 2-year follow-up study of incidence and risk factors

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 su rgery,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.