乳腺癌相关淋巴水肿发病情况及危险因素回顾队列研究

Incidence and risk factors for breast cancer-related lymphedema：a retrospective cohort study

目的：了解国内乳腺癌相关淋巴水肿的发病情况，并分析其相关的危险因素。方法对281例接受手术治疗的初治乳腺癌患者的临床资料和 BCRL 的发病情况进行回顾分析，采用Norman问卷和周径测量法对BCRL的发病情况进行评估，并应用χ^2检验和二分类Logistic回归分析法对淋巴水肿发生的危险因素进行因素分析。结果整组患者Norman问卷和周径测量两种诊断方法的BCRL发病率分别为31.7％和27.0％。多因素分析发现术后接受放疗（ HR＝2.87，P＝0.042）、术前高体重指数≥24 kg／m^2（ HR＝2.54，P＝0.011）、腋窝淋巴结清扫范围大（ HR＝1.97，P＝0.037）、腋淋巴结检测数目多（ HR＝1.06，P＝0.023）都会增加BCRL发病风险。另外，合并高血压患者的BCRL发生风险是血压正常患者的1.74倍（ P＝0.044）。结论 BCRL仍有较高发病率，但大多数患者为轻度水肿。术后放疗、腋窝淋巴结清扫范围大、腋淋巴结检测数目多、术前高体重指数及合并高血压是发生BCRL的危险因素。

Objective To determine the incidence of breast cancer-related lymphedema （ BCRL） in China and to analyze the associated risk factors. Methods A retrospective analysis was performed on the clinical data and the incidence of BCRL in 281 patients who were newly diagnosed with breast cancer and received surgery. The incidence of BCRL was evaluated using arm circumference measurement and Norman questionnaire. The risk factors for lymphedema were analyzed using chi.square test and logistic regression model. Results In all patients,the incidence rates of BCRL determined by arm circumference measurement and Norman questionnaire were 31.7% and 27.0%, respectively. The multivariate analysis showed that postoperative radiotherapy,a preoperative body mass index no less than 24 kg/m^2 ,a large axillary lymph node dissection area,and a large number of positive axillary lymph nodes significantly increased the risk of BCRL （HR=2.87,P=0.042;HR=2.54,P=0.011;HR=1.97,P=0.037;HR=1.06,P=0.023）. Moreover, patients with breast cancer and hypertension had 1.74-fold higher risk of BCRL than those with normal blood pressure. Conclusions The incidence of BCRL is still very high. However,most of patients only have mild edema. Postoperative radiotherapy, a large axillary lymph node dissection area, a large number of positive axillary lymph nodes,a high preoperative body mass index,and hypertension are risk factors for BCRL.