Prognostic factors for lymphedema after primary treatment of breast carcinoma

• Published in: Cancer Vol. 92; no. 7; pp. 1783 - 1787
• Main Authors: Herd‐Smith, Andrea, Russo, Antonio, Muraca, Maria Grazia, Del Turco, Marco Rosselli, Cardona, Gaetano
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01.10.2001; Wiley-Liss
• Subjects: Adult; Aged; arm lymphedema; Biological and medical sciences; breast neoplasms; Breast Neoplasms - therapy; Female; Gynecology. Andrology. Obstetrics; Humans; Lymph Node Excision; Lymphatic Metastasis; Lymphedema - etiology; Mammary gland diseases; Mastectomy; Medical sciences; Middle Aged; Postoperative Complications; Prognosis; Proportional Hazards Models; Radiotherapy; Risk Factors; Tumors; Antineoplastic agent; Human; Postoperative; Carcinoma; Prognosis; Lymph node; Toxicity; Adjuvant treatment; Cardiovascular disease; Malignant tumor; Radiotherapy; Invasion; Lymphatic vessel disease; Mammary gland diseases; Chemotherapy; Clinical stage; Treatment; Lymphedema; Surgery; Female; Combined treatment; Mammary gland; Predictive factor
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(20011001)92:7<1783::AID-CNCR1694>3.0.CO;2-G

BACKGROUND Lymphedema of the arm is a serious consequence of breast carcinoma treatment. Postmastectomy lymphedema of the upper limb usually is related to certain risk factors such as axillary surgery, radiotherapy, obesity, venous outflow obstruction, delayed wound healing, and infection. The objective of the current study was to identify the risk factors for secondary lymphedema after breast carcinoma treatment. METHODS A total of 1278 breast carcinoma patients, all of whom were residents of Florence area, Italy at the time of diagnosis and who were operated on by the same surgeon between 1989 and 1997, were included in the current analysis. The circumference of the upper arm was measured and lymphedema was defined as being present when an increase of > 5% of the sum differences between the two arms was found. The observed cumulative probability of lymphedema occurrence was estimated using the Kaplan–Meier method. The Cox proportional hazards models were fitted to assess the relative excess risk of lymphedema and to check for confusing factors. All patients with lymphedema who were living in the Florence area were referred to a specialist for treatment. RESULTS Two hundred three cases of lymphedema of the ipsilateral arm were found (15.9%). The right arm was affected in 44.5% of the cases and the left arm in 55.5%. The risk of developing late lymphedema was found to be significantly related to a pathologic T2 classification (hazards ratio [HR] = 1.44; 95% confidence interval [95% CI], 1.06–1.94) and postoperative radiotherapy (HR = 1.35; 95%CI, 1.00–1.83). Patients who had > 30 lymph nodes removed were found to have a borderline increased risk of lymphedema (HR = 1.64; 95% CI, 0.99–2.74). Multivariate analysis identified postoperative radiotherapy (HR = 1.38; 95% CI, 1.02–1.86) and the number of lymph nodes removed (HR = 1.29; 95% CI, 1.04–1.59) to be independent predictors of lymphedema. CONCLUSIONS The results of the current study demonstrated that the risk of lymphedema was correlated with the use of postoperative radiotherapy and the number of lymph nodes removed. Cancer 2001;92:1783–7. © 2001 American Cancer Society. A total of 1278 breast carcinoma patients who were surgically treated between 1989 and 1997 were followed for the occurrence of lymphedema; 203 cases of lymphedema of the ipsilateral arm (15.9%) were found. The number of lymph nodes removed and the use of radiotherapy were identified as being significant prognostic factors that appear to increase the risk of lymphedema of the arm in patients with dissection of axillary lymph nodes.