title: Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer.
abstract: OBJECTIVE
  The purpose of this study is to identify risk factors for transient lymphedema (TLE) and persistent lymphedema (PLE) following treatment for breast cancer.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.|Department of Radiation Oncology, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
authors.forename: Myungsoo
authors.initials: M
authors.lastname: Kim
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.|Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyung Hwan
authors.initials: KH
authors.lastname: Shin
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: So-Youn
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Seeyoun
authors.initials: S
authors.lastname: Lee
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Han-Sung
authors.initials: HS
authors.lastname: Kang
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Lee
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Chung
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Yeon-Joo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Kwan Ho
authors.initials: KH
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D001952:Bridged-Ring Compounds / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008209:Lymphedema / Q000139:chemically induced / Q000503:physiopathology*; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D043823:Taxoids / Q000009:adverse effects*
chemical_list: D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane
keywords: Breast neoplasms; Persistent lymphedema; Risk factors; Transient lymphedema