Incidence and risk factors of lymphedema after breast cancer

Ana Carolina Padula Ribeiro Pereira, Rosalina Jorge Koifman, Anke Bergmann. The Breast 36 (2017) 6

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Incidence and risk factors of lymphedema after breast cancer

Ana Carolina Padula Ribeiro Pereira, Rosalina Jorge Koifman, Anke Bergmann. The Breast 36 (2017) 6.ce

Purpose: To evaluate the incidence and risk factors of lymphedema 10 years after surgical treatment for breast cancer.

Methods: Prospective observational hospital-based cohort of women undergoing axillary lymph node dissection. Lymphedema was assessed by indirect volume, measured by circumference, and diagnosed if there was a difference of 200 mL between the arms or if the patient was treated for it. Independent variables were patient, tumour and treatment characteristics. Descriptive statistics were conducted as survival analysis using the Kaplan-Meier estimate. Cox regression was performed, considering a 95% confidence interval (95%CI).

Results: The study evaluated 964 women. The cumulative incidence of lymphedema observed was 13.5% at two years of follow-up, 30.2% at five years and 41.1% at 10 years. Final model showed an increased risk for lymphedema among women that underwent radiotherapy (HR ¼ 2.19; 95%CI 1.63e2.94), were obese (HR ¼ 1.52; 95%CI 1.20e1.92), had seroma formation after surgery (HR ¼ 1.46; 95%CI 1.14e1.87), underwent chemotherapy infusion in the affected limb (HR ¼ 1.45; 95%CI 1.12e1.87) or advanced disease staging (HR ¼ 1.41; 95%CI 1.11e1.80).

Conclusions: Cumulative incidence of lymphedema was 41.1%. Women undergoing axillary radiotherapy, obese, who developed seroma, underwent chemotherapy infusion in the affected limb and with advanced disease had a higher risk of lymphedema

Main findings

  • The outcome “lymphedema” was assessed at baseline (before surgical procedure) and during the follow-up using a circumference measure that was taken at 14 and 7 cm above, and 6, 14 and 21 cm below, the elbow joint. The volume of each arm was estimated by the formula for the volume of the frustum of a cone, and lymphedema was diagnosed if there was a difference of 200 ml between the arms.
  • Chemotherapy was performed in the majority of patients, and 27.6% had at least one cycle of chemotherapy in the affected upper limb. Adjuvant radiotherapy and hormonal therapy was also performed by the majority of patients. In most of the cases, women had a mastectomy (65.1%), ALND until level III (83.8%), a mean of 17.85 (SD =7.52) lymph nodes removed and 4.46 positive lymph nodes (SD =4.84).
  • The suction drain was kept for a mean period of 12.59 (SD ¼ 2.90) days. The observed complications, related to the surgical wound, were seroma (62.6%), nechrosis (40.7%) and infection (12.9%). Considering functional complications, 81.7% had paresthesia in the intercostobrachial nerve, 33.8% had axillary web syndrome and 66.3% had winged scapula.
  • The cumulative incidence of lymphedema was 13.5% in two years, 30.2% in five years and 41.1% in 10 years.
  • After adjustment, an increased risk of lymphedema was observed among women that underwent radiotherapy (HR ¼=19; 95%CI 1.63-2.94), were obese (HR = 1.52; 95%CI 1.20-1.92), had seroma formation after surgery (HR = 1.46; 95%CI 1.14-1.87), underwent chemotherapy infusion in the affected limb (HR = 1.45; 95%CI 1.12-1.87) or advanced disease staging (HR = 1.41; 95%CI 1.11-1.80).