乳腺癌新辅助化疗患者上肢淋巴水肿的危险因素分析

Anylasis of risk factors for arm lymphedema in breast cancer patients treated with neoadjuvant chemotherapy

背景与目的:局部晚期乳腺癌新辅助化疗后联合其他局部治疗,如手术、放疗后患者的上肢淋巴水肿的相关危险因素尚未完全明确。该研究旨在回顾性分析新辅助化疗后患者上肢淋巴水肿的发生率及相关危险因素。方法:回顾分析2007年1月—2012年12月共103例乳腺癌新辅助化疗后行手术(包含腋淋巴结清扫)的患者。所有患者术后接受了全乳或胸壁以及锁上野放疗。淋巴水肿的诊断采用上肢周径测量法。结果:中位随访时间4.5年,41例患者发生上肢淋巴水肿。4.5年淋巴水肿的累积发生率为39.8%。分析结果显示:腋窝淋巴结切取个数大于15(HR=2.455;P=0.006)与完成足疗程新辅助化疗(HR=2.199;P=0.014)为发生淋巴水肿的独立危险因素。结论:该研究患者中有超过1/3的患者在治疗完成后的4~5年内发生患侧上肢的淋巴水肿。腋窝淋巴结切取个数大于15以及完成足疗程新辅助化疗的患者发生淋巴水肿的风险较高,因而对这部分患者需要更加密切的随访以便使淋巴水肿能够被早期发现和治疗。

Background and purpose： The risk of arm lymphedema in locally advanced breast cancer patients treated with neoadjuvant chemotherapy and local treatment （e.g., surgical procedure and radiation therapy） has not been fully clarified so far. This study was conducted to retrospectively investigate the incidence of lymphedema and associated risk factors in patients treated with neo-adjuvant chemotherapy. Methods： A total of 103 breast cancer patients who underwent neo-adjuvant chemotherapy followed by surgery with axillary lymph node （ALN） dissection from Jan. 2007 to Dec. 2012 were retrospectively analyzed. All patients received postoperative breast/chest wall and supraclavicular field radiation therapy. The determination of lymphedema was based on arm circumference measurement. Results： At a median follow-up time of 4.5 years, 41 patients developed lymphedema. The overall 4.5-year cumulative incidence of lymphedema was 39.8%. According to the analysis result, the number of dissected ALN〉15 [ hazard ratio （HR）=2.455; P=0.006] and having full course of neo-adjuvant chemotherapy （HR=2.199; P=0.014） were independent risk factors for lymphedema. Conclusions： More than 1/3 of the patients in our setting developedlymphedema. Those who have the number of dissected ALN〉I 5 and full course of neo-adjuvant chemotherapy are more likely to develop lymphedema. Thus, more frequent surveillance are necessary for them to detect and treat lymphedema at an early stage.