Risk factors for the development of severe breast cancer-related lymphedema: a retrospective cohort study

BMC Cancer

Research

Lingli Xia¹  Hongjian Yang¹  Kefeng Lu²  Yongfeng Li³  Kewang Sun³  Xuli Meng³  Xiaozhen Liu³ 

[1]Department of Breast Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, Hangzhou, Zhejiang, China

[2]Department of outpatient service, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022, Hangzhou, Zhejiang, China

[3]Cancer center, Department of Ultrasound Medicine, Affiliated People’s Hospital, Zhejiang Provincial People’s Hospital, Hangzhou Medical college), 310014, Hangzhou, Zhejiang, China

[4]General Surgery, Cancer center, Department of Breast Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), 310014, Hangzhou, Zhejiang, China

关键词: Lymphedema;    Nomogram;    Lymph node;    Chemotherapy;    Radiotherapy;   

DOI  :  10.1186/s12885-023-10814-5

 received in 2022-12-29, accepted in 2023-04-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSevere lymphedema presents a challenge in terms of treatment due to the significant formation of scar tissue that accompanies it. The aim of this study was to identify intraoperative and preoperative risk factors of severe lymphedema and to develop a nomogram for estimating the risk of severe lymphedema within 3 years of surgery.MethodData was collected from a retrospective cohort of 326 patients with BCRL at the Zhejiang Cancer Hospital from November 2015 to November 2018. Univariate and multivariate logistic regression analysis was conducted to identify predictive indicators of severe lymphedema. A nomogram was developed to further improve the clinical applicability.ResultsIn the retrospective cohort, the ratio of severe/non-severe lymphedema within 3 years of surgery was 1:3. Independent risk factors for severe lymphedema were determined to be age, positive lymph nodes, interpectoral (Rotter’s) lymph nodes (IPNs) dissection, and educational level. IPNs dissection was found to contribute greatly to the development of severe lymphedema with a higher odds ratio (7.76; 95% CI: 3.87–15.54) than other risk factors. A nomogram was developed by integrating age, positive lymph nodes, IPNs dissection, and educational level, which yielded a C-index of 0.810 and 0.681 in the training and validation cohort, respectively. This suggested a moderate performance of the nomogram in predicting the risk of severe lymphedema within 3 years of surgery. The cut-off values of the low-, medium- and high-risk probabilities were 0.0876 and 0.3498, and the severe lymphedema exhibited a significantly higher risk probability as compared with the non-severe lymphedema.ConclusionThis study identified the risk factors of severe lymphedema and highlighted the substantial contribution of IPNs dissection to the severity of lymphedema.

【 授权许可】

CC BY   
© The Author(s) 2023

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