| PartⅠ Prevalence and Associated Factors of Breast Cancer-Related Lymphedema: A retrospective cohort studyBackground: In recent years, with increasingly successful outcomes following treatment of breast cancer, complications such as breast cancer related lymphedema(BCRL) are gain greater importance. Lymphedema causes feared physical and psychosocial side effects and negtively impacts quality of life. Because the ways of diagnosing and measuring BCRL are varies, the prevalence and associated factors of BCRL are different in literatures. The studys of BCRL are even rarely reported in China. This study aimed to describe the incidence, degree, and risk factors of lymphedema in Chinese breast cancer survivors.Methods and Materials: This study total included 281 women with a median age of 50(26-77) years who underwent surgery for unilateral breast cancer in three hospitals from January 2010 to December 2011. The Norman questionnaire and circumference measurement were used to assess BCRL. Lymphedema was defined as a difference ≧2cm in the upper arm circumference between the nonsurgical and surgical arms. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema.Results: The overall incidence of lymphedema, assessed by Norman questionnaire and circumference measurement, were 31.7%(n=89, 95%CI, 26.3-37.1%) and 27.0%(n=76, 95%CI, 21.8%-32.2%), respectively. Multivariate analysis showed that radiation therapy(HR=2.87, P=0.042),greater number of axillary lymph node dissection(HR=1.06, P=0.023), method of axillary surgery(HR=1.97, P=0.037), higher preoperative body mass index(BMI)(HR=2.54, P=0.011) and hypertension(HR=1.74, P=0.044) increased lymphedema risk.Conclusions: Patients who underwent the treatment of breast cancer were suffering an appreciable incidence of arm lymphedema. Radiation therapy, greater number of axillary lymph node dissection, method of axillary surgery, higher BMI and hypertension were independent risk factors for lymphedema. PartⅡ Lymphedema after surgical treatment for breast cancer: A 2-Year follow-up study of incidence and risk factorsAbstractBackground: As cancer treatments evolve, breast cancer mortality rates have significant declined. It is important to preventing and managing morbidity resulting from treatment effects in order to maximize the quality of life of breast cancer survivors. Breast cancer-related lymphedema(BCRL) is one of the most distressing long-term consequences of breast cancer treatment. But the reported incidence of BCRL varies greatly and it is insufficient about the data on the specific time and the time course of lymphedema. This study aimed to describe the incidence trend with time, degree, and risk factors of lymphedema in breast cancer survivors.Materials and methods: We conducted a 2-year prospective study of 157 women who had surgical treatment in the Second Affiliated Hospital of Soochow University from Jan. 1, 2012 to Dec. 31, 2012. Limb volume and symptom assessment data were measured pre-treatment and at month 1, 3, 6, 12, 18, 24 after surgery by circumferences and questionnaires. Definition of BCRL was an absolute change of 2cm or more in arm circumference compared to pre-operative measurements of the same arm by clinical assessment, the questionnaire was based loosely on the telephone questionnaire to characterize lymphedema of Norman. Analysis of risk factors for the development of BCRL was performed finally. Univariate analysis was performed by using log-rank test, and multivariable analysis was performed by using Cox regression.Results: A total of 141 patients were available for evaluation. The median age was 51 years(range, 24–81). The incidences of BCRL by self-reported were 3.5%, 9.2%, 13.5%, 24.8%, 28.4% and 30.5% at the month 1, 3, 6, 12, 18, 24 after surgery. The rates measured using arm circumference were 1.4%, 3.5%, 9.2%, 20.6%, 27.0% and 27.7% changing over time and slightly lower than those by questionnaire. And among the 39(27.7% of 141) affected women following the results of clinical assessment, 31 were reported mild lymphedema. Radical mastectomy(RM, HR=2.19, 95%CI, 1.07-4.49), axillary lymph node dissection(ALND, HR=13.58, 95%CI, 2.17-85.00), radiotherapy(HR=3.54, 95%CI, 1.13-11.07), the numbers of lymph nodes removed(HR=1.11, 95%CI, 1.05-1.16) were independent risk factors for BCRL. Body mass index(BMI), age, hypertension, receipt of chemotherapy and/or hormonal therapy had no significant effect on development of BCRL in this study.Conclusions: BCRL is common complication for breast cancer patients but mostly mild. It can be diagnosed just 1 month post-surgery and the cumulative incidence of BCRL seems to increase with time up to 2 years from surgery, especially in first year, it increases faster. RM, ALND, and radiotherapy were independent risk factors in development of BCRL. |
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