title: Risk Factors for Arm Lymphedema in a Cohort of Breast Cancer Patients Followed up for 10 Years.
abstract: BACKGROUND
  The etiology of lymphedema is multifactorial, and definition criteria of lymphedema, its limitation, and follow-up must be considered in studies related to risk factors. The aim of this study is to evaluate risk factors related to arm lymphedema in a cohort study with a long follow-up.
  
  
  METHODS
  The study was performed in 622 breast cancer patients. The main endpoint reported was the presence of clinical lymphedema reported in medical records. Univariate and multivariate regression analyses were performed to identify factors related to lymphedema.
  
  
  RESULTS
  66.4% of the patients were submitted to mastectomy, 88.4% to level III axillary lymphadenectomy, 34.9% to radiotherapy in the supraclavicular fossa, and 4.3% to axillary radiotherapy. The mean follow-up was 96.7 months. 45 patients (7.2%) developed lymphedema, of which 82.2% had developed lymphedema at 60 months. Univariate regression analysis showed that supraclavicular radiotherapy, adjuvant/palliative chemotherapy, ≥ 15 lymph nodes dissected, and axillary surgery increase the lymphedema rate by 1.87, 2.28, 2.03, and 6.17, respectively. Adjusted multivariate regression analysis showed that the combination of axillary dissection and number of lymph nodes dissected was the main factor related to lymphedema (p = 0.017).
  
  
  CONCLUSIONS
  In the pre-sentinel era, axillary dissection and the number of lymph nodes resected are related to 10-year lymphedema.
authors.affiliation: Mastology and Breast Reconstruction Department, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: René Aloisio da Costa
authors.initials: RA
authors.lastname: Vieira
authors.affiliation: Hospital-based Cancer Registry, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Allini Mafra
authors.initials: AM
authors.lastname: da Costa
authors.affiliation: Mastology and Breast Reconstruction Department, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Josue Lopes
authors.initials: JL
authors.lastname: de Souza
authors.affiliation: Department of Physiotherapy, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Rafael Richieri
authors.initials: RR
authors.lastname: Coelho
authors.affiliation: Epidemiology and Biostatistics Nucleus, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Cleyton Zanardo
authors.initials: CZ
authors.lastname: de Oliveira
authors.affiliation: Department of Physiotherapy, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Almir José
authors.initials: AJ
authors.lastname: Sarri
authors.affiliation: Department of Radiotherapy, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Renato José Affonso
authors.initials: RJ
authors.lastname: Junior
authors.affiliation: Mastology and Breast Reconstruction Department, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Zucca-Matthes
keywords: Breast cancer; Lymph node dissection; Lymphedema; Radiotherapy; Risk factors