Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?
Identifieur interne : 003C76 ( Main/Exploration ); précédent : 003C75; suivant : 003C77Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?
Auteurs : Michelle C. Specht [États-Unis] ; Cynthia L. Miller [États-Unis] ; Tara A. Russell [États-Unis] ; Nora Horick [États-Unis] ; Melissa N. Skolny [États-Unis] ; Jean A. O'Toole [États-Unis] ; Lauren S. Jammallo [États-Unis] ; Andrzej Niemierko [États-Unis] ; Betro T. Sadek [États-Unis] ; Mina N. Shenouda [États-Unis] ; Dianne M. Finkelstein [États-Unis] ; Barbara L. Smith [États-Unis] ; Alphonse G. Taghian [États-Unis]Source :
- Breast cancer research and treatment [ 0167-6806 ] ; 2013.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Analyse multivariée, Bras (physiopathologie), Facteurs temps, Femelle, Humains, Jeune adulte, Lymphadénectomie (effets indésirables), Lymphoedème (anatomopathologie), Lymphoedème (épidémiologie), Lymphoedème (étiologie), Mastectomie (effets indésirables), Modèles de hasards proportionnels, Période postopératoire, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein (), Tumeurs du sein (anatomopathologie), Études prospectives, Évolution de la maladie.
- MESH :
- anatomopathologie : Lymphoedème, Tumeurs du sein.
- effets indésirables : Lymphadénectomie, Mastectomie.
- physiopathologie : Bras.
- épidémiologie : Lymphoedème.
- étiologie : Lymphoedème.
- Pascal (Inist)
- Adulte, Adulte d'âge moyen, Analyse multivariée, Facteurs temps, Femelle, Humains, Jeune adulte, Modèles de hasards proportionnels, Période postopératoire, Seuil, Cancer du sein, Lymphoedème, Bras, Facteur prédictif, Qualité de vie, Compression, Sujet âgé, Sujet âgé de 80 ans ou plus, Traitement, Précoce, Tumeurs du sein, Études prospectives, Évolution de la maladie.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Arm, Arm (physiopathology), Breast Neoplasms (complications), Breast Neoplasms (pathology), Breast Neoplasms (surgery), Breast Neoplasms (therapy), Breast cancer, Compression, Disease Progression, Early, Female, Humans, Lymph Node Excision (adverse effects), Lymphedema, Lymphedema (epidemiology), Lymphedema (etiology), Lymphedema (pathology), Mastectomy (adverse effects), Middle Aged, Multivariate Analysis, Postoperative Period, Predictive factor, Proportional Hazards Models, Prospective Studies, Quality of life, Threshold, Time Factors, Treatment, Young Adult.
- MESH :
- adverse effects : Lymph Node Excision, Mastectomy.
- complications : Breast Neoplasms.
- epidemiology : Lymphedema.
- etiology : Lymphedema.
- pathology : Breast Neoplasms, Lymphedema.
- physiopathology : Arm.
- surgery : Breast Neoplasms.
- therapy : Breast Neoplasms.
- Adult, Aged, Aged, 80 and over, Disease Progression, Female, Humans, Middle Aged, Multivariate Analysis, Postoperative Period, Proportional Hazards Models, Prospective Studies, Time Factors, Young Adult.
Abstract
The purpose of this study is to evaluate arm volume measurements and clinico-pathologic characteristics of breast cancer patients to define a threshold for intervention in breast cancer-related lymphedema. We prospectively performed arm volume measurements on breast cancer patients using a Perometer. Arm measurements were performed pre- and post-operatively, and change in arm volume was quantified using a relative volume change (RVC) equation. Patient and treatment risk factors were evaluated. Cox proportional hazards models with time-dependent covariates for RVC were used to evaluate whether RVC elevations of ≥3 to <5 % or ≥5 to <10 % occurring ≤3 months or >3 months after surgery were associated with progression to >10 % RVC. 1,173 patients met eligibility criteria with a median of 27 months post-operative follow-up. The cumulative incidence of ≥10 % RVC at 24 months was 5.26 % (95 % CI 4.01-6.88 %). By multivariable analysis, a measurement of ≥5 to <10 % RVC occurring >3 months after surgery was significantly associated with an increased risk of progression to ≥10 % RVC (HR 2.97, p < 0.0001), but a measurement of ≥3 to <5 % RVC during the same time period was not statistically significantly associated (HR 1.55, p = 0.10). Other significant risk factors included a measurement ≤3 months after surgery with RVC of ≥3 to <5 % (p = 0.007), ≥5 to <10 % (p < 0.0001), or ≥10 % (p = 0.023), axillary lymph node dissection (ALND) (p < 0.0001), and higher BMI at diagnosis (p = 0.0028). Type of breast surgery, age, number of positive or number of lymph nodes removed, nodal radiation, chemotherapy, and hormonal therapy were not significant (p > 0.05). Breast cancer patients who experience a relative arm volume increase of >3 to <5 % occurring >3 months after surgery do not have a statistically significant increase in risk of progression to ≥10 %, a common lymphedema criterion. Our data support utilization of a ≥5 to <10 % threshold for close monitoring or intervention, warranting further assessment. Additional risk factors for progression to ≥10 % include ALND, higher BMI, and post-operative arm volume elevation.
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Specht</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Division of Surgical Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Russell, Tara A" sort="Russell, Tara A" uniqKey="Russell T" first="Tara A." last="Russell">Tara A. Russell</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Horick, Nora" sort="Horick, Nora" uniqKey="Horick N" first="Nora" last="Horick">Nora Horick</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Department of Biostatistics, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="O Toole, Jean A" sort="O Toole, Jean A" uniqKey="O Toole J" first="Jean A." last="O'Toole">Jean A. O'Toole</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Department of Physical and Occupational Therapy, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Niemierko, Andrzej" sort="Niemierko, Andrzej" uniqKey="Niemierko A" first="Andrzej" last="Niemierko">Andrzej Niemierko</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Sadek, Betro T" sort="Sadek, Betro T" uniqKey="Sadek B" first="Betro T." last="Sadek">Betro T. Sadek</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Shenouda, Mina N" sort="Shenouda, Mina N" uniqKey="Shenouda M" first="Mina N." last="Shenouda">Mina N. Shenouda</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Finkelstein, Dianne M" sort="Finkelstein, Dianne M" uniqKey="Finkelstein D" first="Dianne M." last="Finkelstein">Dianne M. Finkelstein</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>Department of Biostatistics, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Smith, Barbara L" sort="Smith, Barbara L" uniqKey="Smith B" first="Barbara L." last="Smith">Barbara L. Smith</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Division of Surgical Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street</s1><s2>Boston, MA 02114</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Breast cancer research and treatment</title><title level="j" type="abbreviated">Breast cancer res. treat.</title><idno type="ISSN">0167-6806</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Breast cancer research and treatment</title><title level="j" type="abbreviated">Breast cancer res. treat.</title><idno type="ISSN">0167-6806</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Arm</term><term>Arm (physiopathology)</term><term>Breast Neoplasms (complications)</term><term>Breast Neoplasms (pathology)</term><term>Breast Neoplasms (surgery)</term><term>Breast Neoplasms (therapy)</term><term>Breast cancer</term><term>Compression</term><term>Disease Progression</term><term>Early</term><term>Female</term><term>Humans</term><term>Lymph Node Excision (adverse effects)</term><term>Lymphedema</term><term>Lymphedema (epidemiology)</term><term>Lymphedema (etiology)</term><term>Lymphedema (pathology)</term><term>Mastectomy (adverse effects)</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Postoperative Period</term><term>Predictive factor</term><term>Proportional Hazards Models</term><term>Prospective Studies</term><term>Quality of life</term><term>Threshold</term><term>Time Factors</term><term>Treatment</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse multivariée</term><term>Bras (physiopathologie)</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Jeune adulte</term><term>Lymphadénectomie (effets indésirables)</term><term>Lymphoedème (anatomopathologie)</term><term>Lymphoedème (épidémiologie)</term><term>Lymphoedème (étiologie)</term><term>Mastectomie (effets indésirables)</term><term>Modèles de hasards proportionnels</term><term>Période postopératoire</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tumeurs du sein ()</term><term>Tumeurs du sein (anatomopathologie)</term><term>Études prospectives</term><term>Évolution de la maladie</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Lymph Node Excision</term><term>Mastectomy</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Lymphoedème</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Lymphadénectomie</term><term>Mastectomie</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Bras</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Arm</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Lymphoedème</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Lymphoedème</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Disease Progression</term><term>Female</term><term>Humans</term><term>Middle Aged</term><term>Multivariate Analysis</term><term>Postoperative Period</term><term>Proportional Hazards Models</term><term>Prospective Studies</term><term>Time Factors</term><term>Young Adult</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse multivariée</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Jeune adulte</term><term>Modèles de hasards proportionnels</term><term>Période postopératoire</term><term>Seuil</term><term>Cancer du sein</term><term>Lymphoedème</term><term>Bras</term><term>Facteur prédictif</term><term>Qualité de vie</term><term>Compression</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Traitement</term><term>Précoce</term><term>Tumeurs du sein</term><term>Études prospectives</term><term>Évolution de la maladie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The purpose of this study is to evaluate arm volume measurements and clinico-pathologic characteristics of breast cancer patients to define a threshold for intervention in breast cancer-related lymphedema. We prospectively performed arm volume measurements on breast cancer patients using a Perometer. Arm measurements were performed pre- and post-operatively, and change in arm volume was quantified using a relative volume change (RVC) equation. Patient and treatment risk factors were evaluated. Cox proportional hazards models with time-dependent covariates for RVC were used to evaluate whether RVC elevations of ≥3 to <5 % or ≥5 to <10 % occurring ≤3 months or >3 months after surgery were associated with progression to >10 % RVC. 1,173 patients met eligibility criteria with a median of 27 months post-operative follow-up. The cumulative incidence of ≥10 % RVC at 24 months was 5.26 % (95 % CI 4.01-6.88 %). By multivariable analysis, a measurement of ≥5 to <10 % RVC occurring >3 months after surgery was significantly associated with an increased risk of progression to ≥10 % RVC (HR 2.97, p < 0.0001), but a measurement of ≥3 to <5 % RVC during the same time period was not statistically significantly associated (HR 1.55, p = 0.10). Other significant risk factors included a measurement ≤3 months after surgery with RVC of ≥3 to <5 % (p = 0.007), ≥5 to <10 % (p < 0.0001), or ≥10 % (p = 0.023), axillary lymph node dissection (ALND) (p < 0.0001), and higher BMI at diagnosis (p = 0.0028). Type of breast surgery, age, number of positive or number of lymph nodes removed, nodal radiation, chemotherapy, and hormonal therapy were not significant (p > 0.05). Breast cancer patients who experience a relative arm volume increase of >3 to <5 % occurring >3 months after surgery do not have a statistically significant increase in risk of progression to ≥10 %, a common lymphedema criterion. Our data support utilization of a ≥5 to <10 % threshold for close monitoring or intervention, warranting further assessment. Additional risk factors for progression to ≥10 % include ALND, higher BMI, and post-operative arm volume elevation.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Massachusetts</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name></region><name sortKey="Finkelstein, Dianne M" sort="Finkelstein, Dianne M" uniqKey="Finkelstein D" first="Dianne M." last="Finkelstein">Dianne M. Finkelstein</name><name sortKey="Horick, Nora" sort="Horick, Nora" uniqKey="Horick N" first="Nora" last="Horick">Nora Horick</name><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S." last="Jammallo">Lauren S. Jammallo</name><name sortKey="Miller, Cynthia L" sort="Miller, Cynthia L" uniqKey="Miller C" first="Cynthia L." last="Miller">Cynthia L. Miller</name><name sortKey="Niemierko, Andrzej" sort="Niemierko, Andrzej" uniqKey="Niemierko A" first="Andrzej" last="Niemierko">Andrzej Niemierko</name><name sortKey="O Toole, Jean A" sort="O Toole, Jean A" uniqKey="O Toole J" first="Jean A." last="O'Toole">Jean A. O'Toole</name><name sortKey="Russell, Tara A" sort="Russell, Tara A" uniqKey="Russell T" first="Tara A." last="Russell">Tara A. Russell</name><name sortKey="Sadek, Betro T" sort="Sadek, Betro T" uniqKey="Sadek B" first="Betro T." last="Sadek">Betro T. Sadek</name><name sortKey="Shenouda, Mina N" sort="Shenouda, Mina N" uniqKey="Shenouda M" first="Mina N." last="Shenouda">Mina N. Shenouda</name><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N." last="Skolny">Melissa N. Skolny</name><name sortKey="Smith, Barbara L" sort="Smith, Barbara L" uniqKey="Smith B" first="Barbara L." last="Smith">Barbara L. Smith</name><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G." last="Taghian">Alphonse G. Taghian</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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