Cancer Res Treat.  2016 Oct;48(4):1330-1337. 10.4143/crt.2015.463.

Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer

• Kim M
• Shin KH
• Jung SY
• Lee S
• Kang HS
• Lee ES
• Chung SH
• Kim YJ
• Kim TH
• Cho KH

• KMID: 2356235
• DOI: http://doi.org/10.4143/crt.2015.463

Abstract

PURPOSE
The purpose of this study is to identify risk factors for transient lymphedema (TLE) and persistent lymphedema (PLE) following treatment for breast cancer.
MATERIALS AND METHODS
A total of 1,073 patients who underwent curative breast surgery were analyzed. TLE was defined as one episode of arm swelling that had resolved spontaneously by the next follow-up; arm swelling that persisted over two consecutive examinations was considered PLE.
RESULTS
At a median follow-up period of 5.1 years, 370 cases of lymphedema were reported, including 120 TLE (11.2%) and 250 PLE (23.3%). Initial grade 1 swelling was observed in 351 patients, of which 120 were limited to TLE (34%), while the other 231 progressed to PLE (66%). All initial swelling observed in TLE patients was classified as grade 1. In multivariate analysis, chemotherapy with taxane and supraclavicular radiation therapy (SCRT) were associated with development of TLE, whereas SCRT, stage III cancer and chemotherapy with taxane were identified as risk factors for PLE (p < 0.05). The estimated incidence of TLE among initial grade 1 patients was calculated using up to three treatment-related risk factors (number of dissected axillary lymph nodes, SCRT, and taxane chemotherapy). The approximate ratios of TLE and PLE based on the number of risk factors were 7:1 (no factor), 1:1 (one factor), 1:2 (two factors), and 1:3 (three factors).
CONCLUSION
One-third of initial swelling events were transient, whereas the other two-thirds of patients experienced PLE. Estimation of TLE and PLE based on known treatment factors could facilitate prediction of this life-long complication.

Keyword

Breast neoplasms; Transient lymphedema; Persistent lymphedema; Risk factors

MeSH Terms

Arm
Breast Neoplasms*
Breast*
Combined Modality Therapy*
Drug Therapy
Follow-Up Studies
Humans
Incidence
Lymph Nodes
Lymphedema*
Multivariate Analysis
Risk Factors*

Figure

• 

  Fig. 1. Kaplan-Meier curves of the cumulative incidence of breast cancer–related lymphedema (LE) for transient (A) and persistent (B).

Reference

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