Risk Factors Affecting Breast Cancer-related Lymphedema: Serial Body Weight Change During Neoadjuvant Anthracycline Plus Cyclophosphamide Followed by Taxane.

Park S, Lee JE, Yu J2, Paik HJ, Ryu JM, Kim I, Bae SY, Lee SK, Kim SW, Nam SJ, Kim EK, Kang E, Yang EJ. Clin Breast Cancer. 2017 Jun 21. pii: S1526-8209(16)30518-3

INTRODUCTION:

The aim of our study was to analyze the risk of lymphedema (LE) according to the clinicopathologic factors and to investigate the serial change in body weight during neoadjuvant anthracycline plus cyclophosphamide followed by taxane and its correlation with the incidence of LE.

PATIENTS AND METHODS:

We performed a retrospective 2-center study of 406 patients who had undergone neoadjuvant chemotherapy (NAC) followed by surgery from 2007 to 2014. The regimen included 4 cycles of anthracycline plus cyclophosphamide, followed by 4 cycles of taxane. We investigated the presence and degree of LE using a telephone questionnaire assessment. Weight changes were calculated at each cycle of NAC, and the baseline and preoperative body weights were used to calculate the rate of change to account for the change in weight before and after NAC.

RESULTS:

Of the 406 patients, 270 answered the questionnaires, of whom 97 (35.9%) experienced LE. The increase in body weight was significant during the 4 cycles of taxane, but the change in weight was not significant during the 4 cycles of anthracycline plus cyclophosphamide. The change in body weight was most significant just after the fourth cycle of taxane (P < .001). The body mass index (BMI) was an independent factor of LE occurrence on multivariate analysis. However, the change in body weight was not a significant factor for the incidence of LE.

CONCLUSION:

Because a BMI ≥ 25 kg/m2 was an independent factor of LE occurrence on multivariate analysis, patients with a preoperative BMI ≥ 25 kg/m2 should be closely monitored for LE given their increased risk, and monitoring and education should be initiated before surgery and continued throughout the course of NAC.