乳腺癌改良根治术后放疗患者上肢淋巴水肿与腋淋巴结手术结果的相关性分析

Correlation analysis of upper limb lymphedema and the outcome of axillary lymph node surgery in breast cancer patients treated with postmastectomy radiation therapy

背景与目的:上肢淋巴水肿是乳腺癌常见的治疗相关不良反应,显著影响乳腺癌患者的生存质量。本研究旨在观察乳腺癌改良根治术后放疗患者的上肢淋巴水肿发生情况,分析淋巴水肿发生与患者腋淋巴结手术结果(阳性淋巴结个数、切除淋巴结总数及两者的比值,即淋巴结阳性率)的相关性,以及年龄、体质量指数和其他治疗相关因素对上肢淋巴水肿发生的影响。方法:前瞻性收集2015年1月1日—12月31日在上海市黄浦区中心医院行乳腺癌改良根治术后放疗的患者共202例,采用上肢周径测量法,观察这些患者从放疗开始至放疗结束后12个月期间的上肢淋巴水肿发生情况。结果:共有197例患者完成随访观察,其中38例诊断为上肢淋巴水肿(19.3%)。单因素分析结果显示,发生与未发生上肢淋巴水肿的患者在切除淋巴结总数(P<0.001)、阳性淋巴结个数(P<0.001)与淋巴结阳性率(P=0.002)方面差异均有统计学意义,而在年龄、体质量指数和其他治疗相关因素方面差异无统计学意义。多因素分析结果显示,切除淋巴结总数的增多是乳腺癌改良根治术后放疗患者上肢淋巴水肿发生的独立危险因素(P<0.001)。结论:乳腺癌改良根治术后放疗患者的上肢淋巴水肿发生情况与腋淋巴结手术结果具有相关性,其中切除淋巴结总数的增多是淋巴水肿发生的独立危险因素。因此,对于切除淋巴结总数较多的患者,在制定术后相关治疗方案时要充分重视其较高的乳腺癌相关淋巴水肿发生风险。

Background and purpose： Upper limb lymphedema, which is a kind of treatment-related toxicity commonly seen in breast cancer patients, significantly affects the quality of life in this population. The aim of this study was to observe the onset of upper limb lymphedema in breast cancer patients treated with postmastectomy radiation therapy（PMRT）, and to analyze the correlation between lymphedema and the outcome of axillary lymph node surgery（number of positive lymph nodes, total number of dissected lymph nodes and the ratio of the two, also called positive lymph node ratio）, and the influence of age, body mass index and other treatment-related factors on lymphedema. Methods： In this study, 202 breast cancer patients treated with PMRT in Shanghai Huangpu District Central Hospital from Jan. 2015 to Dec. 2015 were prospectively collected. The onset of upper limb lymphedema in these patients from the beginning of radiation therapy to the 12 th month after radiotherapy was observed by using upper limb circumference measurement. Results： One hundred and ninety-seven patients accomplished the follow-up and among them, 38 were diagnosed with upper limb lymphedema（19.3%）. In univariate analysis, number of positive lymph nodes（P〈0.001）, total number of dissected lymph nodes（P〈0.001） and positive lymph node ratio（P=0.002） between patients with and without lymphedema were significantly different, while age, body mass index and other treatment-related factors were not significantly different. In multivariate analysis, an increase in total number of dissected lymph nodes was the onlyindependent risk factor for lymphedema in patients treated with PMRT（P 0.001）. Conclusion： The onset of upper limb lymphedema in breast cancer patients treated with PMRT had correlation with the outcome of axillary lymph node surgery. An increase in total number of dissected lymph nodes was the independent risk factor for lymphedema. For patients with larger total number of dissected lymph nodes, we should take its risk for lymphedema into full consideration in the decision of postoperative treatment for breast cancer patients.