Risk factors and prediction model for persistent breast-cancer-related lymphedema: a 5-year cohort study

I-Wen Penn1,2,3 & Yue-Cune Chang4 & Eric Chuang5 & Chi-Ming Chen6 & Chi-Feng Chung7 & Chia-Yu Kuo8 & Tien-Yow Chuang3,8. Supportive Care in Cancer

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Risk factors and prediction model for persistent breast-cancer-related lymphedema: a 5-year cohort study

I-Wen Penn1,2,3 & Yue-Cune Chang4 & Eric Chuang5 & Chi-Ming Chen6 & Chi-Feng Chung7 & Chia-Yu Kuo8 & Tien-Yow Chuang3,8. Supportive Care in Cancer

Purpose

Breast-cancer-related lymphedema (BCRL) can be a transient or persistent condition. The aims of this study were to (1) identify and weigh the risk factors for persistent lymphedema (PLE) among all patients with BCRL and (2) establish a prediction model for the occurrence of PLE.

Methods A cohort of 342 patients with BCRL with a median follow-up of 5 years after the onset of swelling was analyzed. PLE was defined as a hardening of the subcutaneous tissue, the persistence of the circumferential difference (CD) between arms, or a flare-up of swelling during follow-up. Multiple logistic regression was used to identify risk factors for PLE, including tumors, treatments, and patient-related factors. The prediction accuracy of the model was assessed using the area under the receiver operating characteristic curve (AUC).

Results Of the 342 patients with BCRL, 229 (67%) had PLE. Multiple logistic regression analysis revealed that the number of lymph node metastases (p=0.012), the maximal CD between arms at the first occurrence of swelling (p<0.001), and the largest difference during follow-up (p<0.001) were significant predictors for PLE. The corresponding AUC was 0.908. Although inclusion of bodyweight gains (p=0.008) and maximal CD at the latest follow-up (p=0.002) increased the analytical accuracy (AUC=0.920), the resulting AUC values (p=0.113) were not significantly different.

Conclusions BCRL is persistent in two thirds of patients. Patients with more lymph node metastases, weight gain, and larger CD since the onset of swelling and during follow-up have an increased likelihood of developing PLE.

Main findings

  • N=342
  • Most patients with BCRL (78.9%) started to experience swelling within 3 years after surgery. One third of patients with BCRL did not progress further, or even resolve without any flare-up, whereas two thirds of patients with BCRL were diagnosed with PLE during follow-up.
  • The increment of one instance of lymph node metastasis increased the risk of PLE by 8%. Lymphatic function could be impaired by tumor growth and further damaged by the surgical removal of the lymph nodes.
  • Data showed that patients treated with taxane based CT were more prone to develop PLE, and patients who did not receive CT or underwent CT without taxane tended to exhibit TLE.
  • This study demonstrated a prediction model for PLE using three risk factors: more lymph node metastases, more weight gain from surgery to the onset of swelling, and larger CD between arms. On the basis of these results, we encourage the early diagnosis of breast cancers, appropriate body weight control for postoperative patients, and early education on manual lymph drainage for high-risk patients.