Breast cancer-related lymphedema:A literature review for clinical practice

Lymphedema is the swelling of soft tissues as a result of the accumulation of protein-rich fluid in extracellular spaces.Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels.Secondary lymphedema is a potential complication that may affect the quality of life of patients treated for breast cancer.Lifelong risk factors of post-breast cancer lymphedema are related to the extent of axillary node involvement,type of breast surgery,and radiation therapy.These factors decrease lymphatic drainage and increase stasis of fluids in the areas of skin and subcutaneous tissues that drain to regional lymph nodes.Breast cancer-related lymphedema can involve the arm and hand,as well as the breast and trunk on the operative side.Clinical symptom assessment and circumferential measures are widely used to evaluate lymphedema.Treatment of lymphedema associated with breast cancer can include combined modality approaches,compression therapy,therapeutic exercises,and pharmacotherapy.

Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.

Effects of weight-lifting or resistance exercise on breast cancer-related lymphedema:A systematic review

The purpose of this systematic review was to identify the effects of weight-lifting or resistance exercise on breast cancer-related lymphedema.Published articles written in English were retrieved from electronic databases,including ScienceDirect,PubMed,Scopus,and CINAHL databases.Hand-searches for unpublished papers were also completed.Content analysis was used to examine articles that met the inclusion criteria.Among 525 searched papers,15 papers met the inclusion criteria:13 trials evaluated weight-lifting or resistance exercise alone and two trials evaluated weight-lifting or resistance exercise plus aerobic exercise.The results of the review showed that no arm volume change was observed for either exercise modality.In addition,six included studies showed that weight-lifting or resistance exercise did not cause lymphedema or adverse events in patients at risk of breast cancer-related lymphedema.For patients with breast cancer-related lymphedema,six studies reported that change of swelling outcome measures were not significantly different between the weight-lifting or resistance exercise group and the control group.However,three included studies reported that volume of arm was significantly more reduced in the weight-lifting or resistance exercise group than those in the control group.The findings suggest that supervised resistance exercise may be safe,feasible,and beneficial in patients with breast cancer-related lymphedema or at risk for breast cancer-related lymphedema.However,the limitation of small sample size implies that further research is needed to confirm these findings.

A scoring system for predicting the risk of breast cancer-related lymphedema

Objective:We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema.Methods:From April 2017 to December 2018,533 patients who previously underwent surgery for breast cancer were enrolled in this cross-sectional study.Univariate analysis was performed to explore and define the risk factors.A scoring system was then established on the basis of odds ratio values in the regression analysis.Results:The additive scoring system values ranged from 6 to 22.The receiver operating characteristic(ROC)curve of this scoring system showed a sensitivity and specificity of 83.3%and 57.3%,respectively,to predict the risk of lymphedema at a cut-off of 15.5 points;the area under the curve was 0.736(95%confidence interval:0.662-0.811),with x2=5.134(P=0274)for the Hosmer-Lemeshow test.Conclusions:The predictive efficiency and accuracy of the scoring system were acceptable,and the system could be used to predict and screen groups at high risk for breast cancer-related lymphedema.

Bloodletting puncture and cupping as an adjuvant therapy for breast cancer-related lymphedema in female adults: A non-randomized controlled pragmatic trial

Objective:To evaluate the effectiveness of bloodletting puncture and cupping in relieving breast cancer-related lymphedema.Methods:We conducted a non-randomized controlled study at the Galactophore Department of the 3rd Affiliated Hospital of Beijing University of Chinese Medicine from March 2013 to December 2014.Seventy-five patients undergoing treatment for breast cancer-related lymphedema were divided into two groups in accordance with the patients' treatment choices:the treatment group (n =50) underwent bloodletting puncture and cupping every 5 days for 15 min/session (one session per day) combined with exercise training once a day for 30 minutes;the control group (n =25) underwent the same exercise training alone.Evaluation indexes were measured before and after treatment;these included arm circumference (at the wrist crease,10 cm distal to the wrist crease,the elbow crease,and 10 cm distal to the elbow crease)and visual analogue scale (VAS) score for pain.The safety of the treatment was also evaluated.Results:The treatment period was 50 days for all 75 patients.At the end of the treatment period,the mean reduction in arm circumference was 1.21 (0.65) cm the treatment group,and 0.58 (0.78) cm in the control group.Compared with the control group,the treatment group had a significantly greater reduction in arm circumference (P =.03) and a significantly lower VAS score for pain (P =.01).No patient in either group experienced any adverse events.Conclusion:Bloodletting puncture and cupping effectively reduces arm circumference and relieves upper limb pain in patients with breast cancer-related lymphedema.Our results provide sufficient basis for exploring cupping as long-term therapy for managing breast cancer-related lymphedema.

Efficacy of Manual Lymphatic Drainage for Breast Cancer-Related Lymphedema

Purpose: The effect of manual lymphatic drainage in patients with breast cancer is controversial. The purpose of this study is to evaluate the role of manual lymphatic drainage (MLD) in breast cancer-related lymphedema treatment. Methods: The electronic databases of EMBASE, PubMed, Web of Science, and The Cochrane Library were searched to find English articles on MLD which were published before January 2020. After two evaluators selected the studies and independently evaluated literature quality, meta-analysis was carried out with RevMan 5.3 software. The outcome index of lymphedema treatment changed in edema volume. Results: The study included six RCTs of 364 patients and the meta-analysis showed no significant difference in the effect of MLD for BCRL compared with other treatments (mean difference, 3.76;95% confidence interval, -35.09 to 42.62;Z, 0.19;p = 0.850). Conclusion: MLD can relieve the body tissue, rapidly improve local condition, and enhance complete decongestive therapy (CDT) efficacy. MLD can prevent BCRL and improve the symptoms of stage I lymphedema. It should be widely applied to prevent BCRL from entering an irreversible state.

Preoperative ultrasound evaluation for lymphaticovenous anastomosis surgery in advanced breast cancer-related lymphedema

Aim:Lymphaticovenous anastomosis(LVA)is the mainstay for treating breast cancer-related lymphedema(BCRL).Preoperative ultrasonography is useful to assess the locations and characteristics of lymphatics and veins to improve LVA success remarkably even in cases of advanced BCRL.Aim:The aim of the study was to describe the use of ultrasonography to reliably map suitable lymphatics and veins and successfully perform LVA surgery in cases of advanced BCRL.Method:This retrospective cohort study included 41 cases of BCRL who underwent LVA surgery using preoperative ultrasound to map and characterize lymphatics and veins.Cases were analyzed for the following:(1)whether preoperative ultrasonographic detection of both lymphatics and veins correlate to actual intraoperative findings and(2)improvement in mean limb circumference measurements at 1 and 3 months of follow-up in this patient cohort.Results:For 155 LVA incisions,212 LVA procedures were performed.Among them,133(62.7%)lymphatics and 196(92.4%)anti-reflux veins were successfully detected and characterized on preoperative sonography.Mean preoperative circumference at the wrist,10cm below elbow,elbow,and 10cm above elbow were 18.86 cm,27.79 cm,29.75 cm,and 33.77 cm,respectively.The mean measurements improved at 1 month correspondingly to 17.14 cm,24.86 cm,26.91 cm,and 30.50 cm(9.12%,10.54%,9.54%,9.70%improvement,respectively),and at 3 months to 16.59 cm,24.28 cm,26.55 cm,and 30.05 cm(12.02%,12.63%,10.73%,11.02%improvement,respectively).For each individual patient,their four measured circumferences were also added to obtain the Total Circumference(TC).The TC ranged from 89-135 cm(mean 109.46 cm)preoperatively,83.5-129.5 cm(mean 98.74 cm)1-month post-op,and 80.5-128 cm(mean 96.55 cm)3 months post-op.Compared to the preoperative value,each patient had a TC decrease of 2.79%-20.35%(mean 9.80%)at 1-month post-op and 4.39-28.30%(mean 11.80%)at 3 months post-op.These differences were all statistically significant(P<0.0001).Conclusion:Preoperative ultrasonography is a useful adjunct to detect lymphatic vessels and anti-reflux veins,thereby increasing the chances of successfully performing LVA surgery even in cases of advanced upper limb lymphedema.It can contribute to long-lasting outcomes.

Combination of lymphovenous anastomosis and lymph node transfer for breast cancer-related lymphedema

With the remarkable advancement of microsurgery,surgical treatment for lymphedema has been increasing,and its good results are well established.However,surgical treatment for advanced-stage lymphedema is still a challenging task.We reviewed several methods of combining lymphovenous anastomosis(LVA)and vascularized lymph node transfer(VLNT)in breast cancer-related lymphedema(BCRL)patients.Representative VLNT flap options for BCRL patients include the omental flap,superficial circumflex iliac perforator(SCIP)flap,and deep inferior epigastric artery(DIEA)flap combined with inguinal lymph nodes performed simultaneously with breast reconstruction.The surgical outcome,technical details,and donor site morbidities of each surgical option were reviewed.While all three options show significant surgical benefits,each has its clear advantages and disadvantages.The decision on the surgical method may vary according to the needs of each patient and the clinical situation.

Management of lymphedema is really a matter in patients with breast cancer

Lymphedema is a prevalent complication affecting patients with breast cancer,greatly impacting their quality of life.This editorial describes diagnostic methods and therapeutic interventions for managing lymphedema in patients with breast cancer.Diagnosis relies on clinical evaluation and objective measures,including arm circumference and volumetric assessments,along with lymphoscintigraphy and ultrasonic measurements.Treatment primarily involves complex decongestive physical therapy,comprising manual lymphatic drainage,compression therapy,exercise,and meticulous skin care.These interventions aim to reduce swelling,alleviate discomfort,and prevent further complications.Additionally,lifestyle modifications such as avoiding extreme temperatures and maintaining proper hygiene are essential.Flavonoids can be used for drug therapy.Despite its prevalence,lymphedema often receives inadequate attention in clinical practice,emphasizing the importance of raising awareness and enhancing medical services for affected individuals.Clinicians play a pivotal role in educating patients about preventive measures and ensuring timely intervention.Overall,a comprehensive approach encompassing early diagnosis,multidisciplinary management,and patient education is essential to mitigate the burden of lymphedema in patients with breast cancer and improve their overall well-being.

Breast cancer-related lymphedema: focus on surgical treatment

Breast cancer-related lymphedema(BCRL)can affect breast cancer patients,especially after axillary surgery and radiation treatment,for life.First line treatment is conservative and involves physical therapy and compression.It requires absolute,life-long compliance with treatment by the patient and,in some cases,it is ineffective.In recent years,surgery has emerged as a possible alternative or even,complementary therapy for BCRL.The most commonly reported techniques are reconstructive or debulking procedures.Reconstructive procedures are aimed at restoring the lymphatic pathways and can be effective early in the disease process,when increased arm volumes are mostly due to the accumulation of protein-rich fluid in the interstitial space.In more advanced stages,where fibrotic and hypertrophic adipose tissues are dominant,debulking techniques such as liposuction can be recommended.A standard of care for the treatment of BCRL has not been established.Currently,different techniques can be combined to optimize clinical outcomes,and the surgical approach must be individualized for each patient,based on sound clinical and imaging assessment.BCRL surgical treatment remains a challenging topic that requires further study before it can be standardized.

Indocyanine green lymphangiography-guided liposuction in breast cancer-related lymphedema treatment-patient selection and technique

Aim:The rationale of using liposuction to treat lymphedema is that the chronic inflammatory process of lymphedema results in fat hypertrophy.The authors describe the technique of indocyanine green lymphangiography-guided liposuction,its rationale,and our patient selection criteria for better clinical outcomes.Methods:Thirty-two patients underwent liposuction for breast cancer-related lymphedema.Indocyanine green lymphangiography was performed prior to liposuction.For patients without linear and splash patterns in indocyanine green lymphangiography,circumferential liposuction was performed liberally.For patients who had linear or splash patterns,liposuction was not performed at regions with remaining functional lymphatic vessels.Outcomes were assessed using circumferential reduction rate.Results:At a mean follow-up of 24.5±6.5 months,all(100%)patients had a reduction in limb circumferences after liposuction.The mean circumference reduction rate was 67.6%±27.9%.Conclusion:Liposuction is a valuable treatment for breast cancer-related lymphedema.We believe patients with fat predominant lymphedema are the best candidates for liposuction.

The Risk Factors of Lymphedema in Breast Cancer Patients Post Axillary Clearance

Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30 - 60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both. Further, the most prevalent complication was pain accounting for 42.1% of total complications, and the least prevalent was cellulitis 4%. Also, seroma developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in none of the patients (0%). Lymphoedema accounted for 16.1% of overall complications, 85% of the patients who developed lymphedema had undergone ALND, and 12.9% and 14.4% received radiotherapy and chemotherapy respectively. Lymphedema was observed in breast cancer stages as follows: stage I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI) of 30 - 39 kg/m2 had 7.2% prevalence of lymphedema compared to other BMI groups. Overall mortality was 8.3%. Conclusion: The findings of our study suggest that the prevalence of lymphedema was higher in ALND patients with locally advanced tumors, and higher BMI, compared to patients with stage I breast cancer and low BMI. Further, the prevalence of lymphedema in patients who underwent ALND was significantly lower than those who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to mastectomy 19.3%.

Vascularized lymph node transfer using axilla as recipient site restores lymphatic flow in upper limb lymphedema:Evidence from magnetic resonance lymphangiography

Background:Lymphedema is a debilitating condition that frequently occurs after breast cancer treatment.Vas-cularized lymph node transfer(VLNT)is a promising approach to reduce lymphedema.This study used magnetic resonance lymphangiography(MRL)to assess lymphatic reconnections post-VLNT in patients with breast cancer-related lymphedema(BCRL).Methods:The clinical records of six female patients with unilateral upper limb BCRL who underwent VLNT(4 cases)or VLNT combined with breast reconstruction(2 cases)were retrospectively reviewed.All patients were examined using MRL preoperatively and at the 1-year follow-up.The morphological characteristics of the lymphatic network,dermal backflow patterns,and architecture of the lymph nodes were evaluated.Clinical outcomes,patient satisfaction,and complications were assessed.Results:At the 1-year follow-up,reduction in tissue edema and limb circumference was achieved in all six patients.In MRL,the implanted lymph nodes in the axillary region of the affected upper arm were enhanced and visualized in all six patients.Reconnected lymphatic vessels in the subcutaneous tissue associated with the implanted lymph nodes were observed in four patients.Decreased dermal backflow and lymphatic vessel dilation of the affected limbs were observed in all six patients.No disruption of the lymph flow in the donor area was detected.Conclusion:This is the first study to provide direct imaging evidence for the reconnection of afferent lymphatic channels between implanted lymph nodes and the recipient lymphatic system in patients with BCRL.Overall,our study demonstrates the mechanism and efficacy of VLNT in reducing lymphedema.

Interventional effect of cognitive behavioral therapy on cancer-related fatigue in breast cancer patients: A systematic review

Objective:To evaluate the effect of cognitive behavioral therapy on cancer-related fatigue in breast cancer patients.Methods:Computer search for CNKI,VIP,Wanfang database,CBM,PubMed,Embase,CINAHL,The Cochrane library as of 2019 randomized controlled trials on October 20 for cognitive behavioral therapy intervention for breast cancer due to fatigue.Results:A total of 6 RCTs were included,472 patients.Cognitive Behavioral Therapy has a strong effect on cancer related fatigue compared with the usual care[SMD=-1.19,95%CI(-1.86,-0.53),P=0.0004].Results:Available evidence suggests that CBT can alleviate cancer-related fatigue in breast cancer patients,and the above studies still need to continue to conduct relevant studies for validation.

Effectiveness of six-step complex decongestive therapy for treating upper limb lymphedema after breast cancer surgery

BACKGROUND Complex decongestive therapy(CDT)is currently recommended as the standard treatment for lymphedema.CDT is a four-step detumescence therapy that can effectively treat upper limb lymphedema after breast cancer surgery,and is considered non-invasive,painless and without side effects.AIM To determine the effectiveness of a six-step CDT involving a foam granule bandage for the treatment of upper extremity lymphedema pressure after breast cancer surgical intervention.METHODS The study included 100 patients with upper extremity lymphedema after breast cancer surgery.The surgical methods were mastectomy plus axillary lymph node dissection and breast preservation plus sentinel lymph node biopsy.The study population was further divided into the experimental group and control group with 50 cases in each group.The control group was given conventional CDT(four-step method),which included skin care,freehand lymphatic drainage,foam granule pressurized bandage,and functional exercise.In the experimental group,a six-step CDT method was applied that involved a foam particle bandage combined with air wave pressure therapy in addition to the four steps of conventional CDT.Patients in both groups were given one course of treatment daily(20 times),and the changes in body moisture and subjective symptoms were measured before and after treatment,preoperatively and 20 times after treatment.RESULTS No statistically significant differences in 50-Hz bioelectrical impedance and extracellular moisture ratio were observed between the two groups before treatment,suggesting comparability of the baseline data.After treatment,the 50-Hz bioelectrical impedance of the experimental group was significantly higher than that in the control group,and the extracellular moisture ratio was significantly lower than that in the control group.A comparison of the differences between the two groups before and after treatment indicated that the treatment effect in the experimental group was better than that in the control group.After 20 treatments,according to subjective evaluations,the tightness and swelling of the limbs in the experimental group were significantly reduced as compared with those in the control group.CONCLUSION The six-step CDT method can effectively reduce lymphedema,promote lymphatic circulation,and alleviate the subjective symptoms of patients,and thereby improve the quality of life and treatment compliance among patients.

Sun-burn induced upper limb lymphedema 11 years following breast cancer surgery: A case report

BACKGROUND Upper arm lymphedema is a common complication one year after breast cancer surgery,which profoundly impacts patients'quality of life.CASE SUMMARY We reported a case of lymphedema induced by prolonged sun exposure 11 years after breast cancer surgery.CONCLUSION Breast screening,patient education and follow-up after hospital discharge could help to prevent upper-arm lymphedema.

Kinesio tape in the treatment of postoperative lymphedema of breast cancer

The Kinesio tape was originally developed by Dr. Kenzo Kase, a Japanese chiropractor, which was used for pain of joint and muscle, the elastic tape is capable of stretching up to 130-140% of its resting static length ensuring free mobility of the applied muscle or joint. It is claimed that Kinesio tape supports injured muscles and joints and helps relieve pain by lifting the skin and allowing improved blood and lymph flow. Therefore, Kinesio Taping has become a very popular treatment for several health conditions over the last decade. Nowadays, lymphatic drainage is a new function of Kinesio taping in the field of physical therapy. This article explores the application of Kinesio tape in breast cancer-related lymphedema in order to provide a new treatment for patients with lymphedema after breast cancer surgery.

Effectiveness of complex decongestive therapy in management of breast cancer associated lymphedema

Background:To assess the edema relief effects of complex decongestive therapy(CDT)in patients with breast cancer associated lymphedema after axillary lymph node dissection(ALND).Methods:58 breast cancer patients with unilateral arm lymphedema after breast cancer ALND were enrolled.The patients were divided into three groups based on the difference of circumference between the affected and unaffected extremity:group 1,mild lymphedema in circumference difference;group 2,moderate lymphedema,and group 3,severe lymphedema.These patients received four weeks of CDT and self-administered home therapy.Arm circumference was measured before,right after CDT,3 months and 12 months of follow-up.Results:In the first group,the circumference difference was 1.53±0.73 cm prior to CDT,and 0.32±0.59 cm right after CDT,and the difference was statistically significant(P<0.001).At the 1-year-follow-up,we got an even higher value than the pre-CDT one,however,there was no significant difference(P=0.175).At the end of CDT,the circumference difference of the third group was 4.52±2.58 cm,significantly lower than the baseline level(8.76±3.07 cm)(P<0.001).In the third group,the reduction of circumference difference was persisted for 12 months.Conclusion:The effects of CDT were maintained for 12 months,while there were differences in progress of circumference difference among the three groups.The effects of patients with severe initial edema(>5 cm increased)last longer.

多元化延续性干预在乳腺癌术后上肢淋巴水肿康复中的应用效果

目的分析多元化延续性干预在乳腺癌患者术后上肢淋巴水肿康复中的应用效果。方法根据干预方法的不同将96例乳腺癌手术患者分为对照组(n=47)和研究组(n=49),对照组患者采用常规干预,研究组患者在对照组的基础上采用多元化延续性干预。比较两组患者的满意度、上肢功能活动情况[臂肩手功能障碍评估表(DASH)]、上肢淋巴水肿情况。结果研究组患者的总满意度为97.96%,明显高于对照组患者的80.85%,差异有统计学意义(P﹤0.01)。干预后,两组患者DASH评分均明显低于本组干预前,研究组患者DASH评分明显低于对照组,差异均有统计学意义(P﹤0.01)。干预后,研究组患者上肢淋巴水肿情况优于对照组(P﹤0.05)。结论多元化延续性干预可减轻乳腺癌患者术后上肢淋巴水肿,促进患者上肢功能恢复,提高满意度,值得临床推广应用。

乳腺癌根治术后淋巴水肿患者康复护理模式构建

目的分析乳腺癌根治术后患者发生淋巴水肿的影响因素,基于独立影响因素构建风险预测模型,并以此构建有针对性的康复护理模式。方法选取2020年9月—2022年8月医院接受乳腺癌根治术治疗的患者212例为研究对象,根据患者术后1年内是否发生淋巴水肿,将患者分为并发淋巴水肿组63例和未并发淋巴水肿组149例,通过单因素分析及多因素Logistic回归分析得出独立影响因素,并基于回归分析法构建风险预测模型,使用R语言软件绘制相应的列线图,采用受试者工作特征(ROC)曲线及校准曲线检验预测效能,并以此构建患者康复护理模式。结果经过多因素Logistic回归分析,本研究结果表明年龄、身体质量指数(BMI)、腋窝淋巴结清扫数量、术后感染、术后规律锻炼、术后健康饮食、抑郁症史均与术后并发淋巴水肿有关(P<0.05),以此构建的风险预测模型其曲线下面积(AUC)0.791,最佳截断值0.335对应的灵敏度、特异度分别为0.698、0.772,校准曲线结果显示,平均绝对误差(MAE)为0.018,校准曲线贴合理想曲线,表示模型具有较好的校准性能,模型较为可靠稳定。结论患者行乳腺癌根治术后发生淋巴水肿受年龄、BMI、腋窝淋巴结清扫数量、术后感染等因素影响,基于各独立影响因素构建的风险预测模型预测性能良好,根据其构建康复护理模式有利于预防或减少术后淋巴水肿的发生。