乳腺癌相关淋巴水肿：危险因素和预测模型

Abstract

Aims

To identify the risk factors for lymphoedema following axillary lymph node dissection (ALND) in a European sample and to propose a lymphoedema prediction model for this population.

Design

Predictive retrospective cohort study comparing women who developed lymphoedema in 2 years of undergoing ALND with those who did not developed lymphoedema.

Methods

We reviewed the clinical records of 504 women who, between January 2008 and May 2018, underwent surgery for breast cancer that involved ALND. Logistic regression was used to identify significant risk factors for lymphoedema. The prediction accuracy of the model was assessed by calculating the area under the receiver operating characteristic curve.

Results

Of the 504 women whose records were analysed, 156 developed lymphoedema. Significant predictors identified in the regression model were level of lymph node dissection, lymph node status, post-operative complications, body mass index (BMI) and number of lymph nodes extracted. The prediction model showed good sensitivity (80%) in the study population.

Conclusions

The factor contributing most to the risk of lymphoedema was the level of lymph node dissection, and the only patient-related factor in the prediction model was BMI. The model offers good predictive capacity in this population and it is a simple tool that breast care units could use to assess the risk of lymphoedema following ALND. Nurses with specialist knowledge of lymphoedema have a key role to play in ensuring that women receive holistic and individualized care.

Impact

What problem did the study address? Secondary lymphoedema is one of the main complications in the treatment of breast cancer. What were the main findings? The prediction model included five factors associated with the risk of lymphoedema following ALND. The strongest predictor was the level of lymph node dissection, and the only patient-related factor was BMI. Where and on whom will the research have an impact? The prediction model offers breast care units a tool for assessing the risk of lymphoedema in women undergoing surgery involving ALND. The results highlight the importance of weight reduction as a preventive measure and support a more conservative surgical approach.

摘要翻译（仅供参考）

目的

确定欧洲样本中腋窝淋巴结清扫 (ALND) 后淋巴水肿的危险因素，并为该人群提出淋巴水肿预测模型。

设计

比较在接受 ALND 2 年内出现淋巴水肿的女性与未出现淋巴水肿的女性的预测性回顾性队列研究。

方法

我们回顾了 2008 年 1 月至 2018 年 5 月期间因涉及 ALND 的乳腺癌接受手术的 504 名女性的临床记录。Logistic 回归用于确定淋巴水肿的重要危险因素。通过计算受试者工作特征曲线下的面积来评估模型的预测准确性。

结果

在对记录进行分析的 504 名女性中，156 名发生了淋巴水肿。回归模型中确定的重要预测因素是淋巴结清扫水平、淋巴结状态、术后并发症、体重指数 (BMI) 和提取的淋巴结数量。预测模型在研究人群中显示出良好的敏感性 (80%)。

结论

对淋巴水肿风险影响最大的因素是淋巴结清扫水平，预测模型中唯一与患者相关的因素是 BMI。该模型在该人群中提供了良好的预测能力，它是一个简单的工具，乳房护理单位可以用来评估 ALND 后淋巴水肿的风险。具有淋巴水肿专业知识的护士在确保女性获得整体和个性化护理方面发挥着关键作用。

影响

研究解决了什么问题？继发性淋巴水肿是治疗乳腺癌的主要并发症之一。主要发现是什么？预测模型包括与 ALND 后淋巴水肿风险相关的五个因素。最强的预测因子是淋巴结清扫的水平，唯一与患者相关的因素是 BMI。研究将在何处和对谁产生影响？该预测模型为乳房护理单位提供了一种工具，用于评估接受 ALND 手术的女性的淋巴水肿风险。结果强调了减轻体重作为预防措施的重要性，并支持更保守的手术方法。

原文链接：

https://onlinelibrary.wiley.com/doi/10.1111/jan.15005

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