title: A model to estimate the risk of breast cancer-related lymphedema: combinations of treatment-related factors of the number of dissected axillary nodes, adjuvant chemotherapy, and radiation therapy.
abstract: OBJECTIVE
  The development of breast cancer-related lymphedema (LE) is closely related to the number of dissected axillary lymph nodes (N-ALNs), chemotherapy, and radiation therapy. In this study, we attempted to estimate the risk of LE based on combinations of these treatment-related factors.
  
  
  METHODS
  A total of 772 patients with breast cancer, who underwent primary surgery with axillary lymph node dissection from 2004 to 2009, were retrospectively analyzed. Adjuvant chemotherapy (ACT) was performed in 677 patients (88%). Among patients who received radiation therapy (n=675), 274 (35%) received supraclavicular radiation therapy (SCRT).
  
  
  RESULTS
  At a median follow-up of 5.1 years (range, 3.0-8.3 years), 127 patients had developed LE. The overall 5-year cumulative incidence of LE was 17%. Among the 127 affected patients, LE occurred within 2 years after surgery in 97 (76%) and within 3 years in 115 (91%) patients. Multivariate analysis showed that N-ALN (hazard ratio [HR], 2.81; P<.001), ACT (HR, 4.14; P=.048), and SCRT (HR, 3.24; P<.001) were independent risk factors for LE. The total number of risk factors correlated well with the incidence of LE. Patients with no risk or 1 risk factor showed a significantly lower 5-year probability of LE (3%) than patients with 2 (19%) or 3 risk factors (38%) (P<.001).
  
  
  CONCLUSIONS
  The risk factors associated with LE were N-ALN, ACT, and SCRT. A simple model using combinations of these factors may help clinicians predict the risk of LE.
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Myungsoo
authors.initials: M
authors.lastname: Kim
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Sung Uk
authors.initials: SU
authors.lastname: Lee
authors.forename: Nam Kwon
authors.initials: NK
authors.lastname: Lee
authors.forename: So-Youn
authors.initials: SY
authors.lastname: Jung
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Lee
authors.forename: Han-Sung
authors.initials: HS
authors.lastname: Kang
authors.forename: Kyung Hwan
authors.initials: KH
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000706:statistics & numerical data; D019583:Dose Fractionation, Radiation; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000706:statistics & numerical data; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods; D008209:Lymphedema / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015411:Mastectomy, Modified Radical / Q000009:adverse effects / Q000379:methods; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal