不同病理分期和分子分型的乳腺癌患者行ARM后水肿发生率的相关性研究

Study on the correlation of edema incidence after ARM technique in patients with breast cancer on different pathological stages and molecular typing

目的:探讨反向腋窝淋巴结示踪(axillary reverse mapping,ARM)后乳腺癌患者上肢淋巴水肿情况与不同病理分期和分子分型之间的相关性。方法:所有乳腺癌患者术中行腋窝淋巴结清扫术(ALND)+ARM术,以亚甲蓝为示踪剂,术后分析不同的病理分期和不同的分子分型患者间的上肢水肿情况。结果:依据病理分期分组和分子分型分组的病例术前基线资料比较差异无统计学意义。病理分期组间水肿发生情况差异有统计学意义(χ~2=21.081,P<0.05);分子分型组间水肿发生情况差异也有统计学意义(χ~2=6.205,P<0.05)。分期较晚及分子分型为Her2阳性或三阴性乳腺癌的患者术后更容易患上肢淋巴水肿。上肢淋巴水肿组年龄大于50岁和体质量指数大于25 kg·m^(-2)者分别占65.6%(21/32)和73.9%(17/23),显著高于非上肢淋巴水肿组的31.0%(9/29)和34.2%(13/38),组间差异均有统计学意义(均P<0.05)。多因素分析显示,在校正了放射治疗与否、糖尿病及饮酒史后,年龄和体质量指数是乳腺癌治疗相关上肢淋巴水肿的危险因素。结论:乳腺癌患者ARM后上肢淋巴水肿发生情况与患者病理分期和分子分型均具有相关性,对年龄大于50岁和体质量指数大于25 kg·m^(-2)的患者在治疗中应予以高度重视,避免淋巴水肿发生。

Objective： To study the correlation between limb lymphedema and pathological stage and molecular typing in patients with breast cancer after axillary reverse mapping（ ARM）. Methods： All patients with breast cancer underwent axillary lymph node dissection（ ALND） ＋ ARM,methylene blue as a tracer were postoperatively analyzed of different pathological staging and different molecular classification among patients upper limb edema.Results： There were no statistically significant differences in the preoperative baseline data between the pathological staging and the subgroups,respectively,and the groups were comparable（ P〈0. 05）. There was a significant difference in the incidence of edema between the two groups of pathological stages（ χ~2= 21. 081,P〈0. 05）. There was a significant difference in the incidence of edema between the two groups of molecular typing（ χ~2= 6. 205,P〈0. 05）. The patients on late pathological stage or Her2-positive or triple-negative breast cancer were more likely to develop lymphedema. Single factor analysis showed that,in the upper limb lymphedema group,patients older than50 years of age accounted for 65. 6%（ 21/32） and these with a body mass index greater than 25 kg·m^（-2）73. 9%（ 17/23）,significantly higher than that of non-upper extremity lymphedema group（ 9/29） and 34. 2%（ 13/38）respectively,the differences between groups were statistically significant（ P〈0. 05）. Multivariate analysis showed that age and body mass index were risk factors for upper limb lymphedema after breast cancer treatment after adjusting for radiation therapy,diabetes and drinking history. Conclusion： The decrease of lymphedema by ARM technology in breast cancer patients is correlated with the pathological stage and molecular typing. For patients older than 50 years old and the body mass index greater than 25 kg·m^（-2）,the patients should be highly valued in the treatment to avoid lymphedema.