Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?
Identifieur interne : 000025 ( PascalFrancis/Corpus ); précédent : 000024; suivant : 000026Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?
Auteurs : Michelle C. Specht ; Cynthia L. Miller ; Tara A. Russell ; Nora Horick ; Melissa N. Skolny ; Jean A. O'Toole ; Lauren S. Jammallo ; Andrzej Niemierko ; Betro T. Sadek ; Mina N. Shenouda ; Dianne M. Finkelstein ; Barbara L. Smith ; Alphonse G. TaghianSource :
- Breast cancer research and treatment [ 0167-6806 ] ; 2013.
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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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| NO : | PASCAL 13-0289629 INIST |
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| ET : | Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression? |
| AU : | SPECHT (Michelle C.); MILLER (Cynthia L.); RUSSELL (Tara A.); HORICK (Nora); SKOLNY (Melissa N.); O'TOOLE (Jean A.); JAMMALLO (Lauren S.); NIEMIERKO (Andrzej); SADEK (Betro T.); SHENOUDA (Mina N.); FINKELSTEIN (Dianne M.); SMITH (Barbara L.); TAGHIAN (Alphonse G.) |
| AF : | Division of Surgical Oncology, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (1 aut., 12 aut.); Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (2 aut., 3 aut., 5 aut., 7 aut., 8 aut., 9 aut., 10 aut., 13 aut.); Department of Biostatistics, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (4 aut., 11 aut.); Department of Physical and Occupational Therapy, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (6 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | Breast cancer research and treatment; ISSN 0167-6806; Coden BCTRD6; Pays-Bas; Da. 2013; Vol. 140; No. 3; Pp. 485-494; Bibl. 67 ref. |
| LA : | Anglais |
| EA : | 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. |
| CC : | 002B20E02; 002B12B04; 002B04C |
| FD : | Seuil; Cancer du sein; Lymphoedème; Bras; Facteur prédictif; Qualité de vie; Compression; Traitement; Précoce |
| FG : | Tumeur maligne; Cancer; Pathologie de la glande mammaire; Pathologie du sein; Pathologie de l'appareil circulatoire; Pathologie des vaisseaux lymphatiques |
| ED : | Threshold; Breast cancer; Lymphedema; Arm; Predictive factor; Quality of life; Compression; Treatment; Early |
| EG : | Malignant tumor; Cancer; Mammary gland diseases; Breast disease; Cardiovascular disease; Lymphatic vessel disease |
| SD : | Umbral; Cáncer del pecho; Linfedema; Brazo; Factor predictivo; Calidad vida; Compresión; Tratamiento; Precoz |
| LO : | INIST-20699.354000501942900060 |
| ID : | 13-0289629 |
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Finkelstein</name><affiliation><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></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><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></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><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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0289629</idno><date when="2013">2013</date><idno type="stanalyst">PASCAL 13-0289629 INIST</idno><idno type="RBID">Pascal:13-0289629</idno><idno type="wicri:Area/PascalFrancis/Corpus">000025</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?</title><author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C." last="Specht">Michelle C. Specht</name><affiliation><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></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><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></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><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></affiliation></author><author><name sortKey="Horick, Nora" sort="Horick, Nora" uniqKey="Horick N" first="Nora" last="Horick">Nora Horick</name><affiliation><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></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><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></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><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></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><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></affiliation></author><author><name sortKey="Niemierko, Andrzej" sort="Niemierko, Andrzej" uniqKey="Niemierko A" first="Andrzej" last="Niemierko">Andrzej Niemierko</name><affiliation><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></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><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></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><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></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><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></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><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></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><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></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>Arm</term><term>Breast cancer</term><term>Compression</term><term>Early</term><term>Lymphedema</term><term>Predictive factor</term><term>Quality of life</term><term>Threshold</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><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>Traitement</term><term>Précoce</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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0167-6806</s0></fA01><fA02 i1="01"><s0>BCTRD6</s0></fA02><fA03 i2="1"><s0>Breast cancer res. treat.</s0></fA03><fA05><s2>140</s2></fA05><fA06><s2>3</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?</s1></fA08><fA11 i1="01" i2="1"><s1>SPECHT (Michelle C.)</s1></fA11><fA11 i1="02" i2="1"><s1>MILLER (Cynthia L.)</s1></fA11><fA11 i1="03" i2="1"><s1>RUSSELL (Tara A.)</s1></fA11><fA11 i1="04" i2="1"><s1>HORICK (Nora)</s1></fA11><fA11 i1="05" i2="1"><s1>SKOLNY (Melissa N.)</s1></fA11><fA11 i1="06" i2="1"><s1>O'TOOLE (Jean A.)</s1></fA11><fA11 i1="07" i2="1"><s1>JAMMALLO (Lauren S.)</s1></fA11><fA11 i1="08" i2="1"><s1>NIEMIERKO (Andrzej)</s1></fA11><fA11 i1="09" i2="1"><s1>SADEK (Betro T.)</s1></fA11><fA11 i1="10" i2="1"><s1>SHENOUDA (Mina N.)</s1></fA11><fA11 i1="11" i2="1"><s1>FINKELSTEIN (Dianne M.)</s1></fA11><fA11 i1="12" i2="1"><s1>SMITH (Barbara L.)</s1></fA11><fA11 i1="13" i2="1"><s1>TAGHIAN (Alphonse G.)</s1></fA11><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></fA14><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></fA14><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></fA14><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></fA14><fA20><s1>485-494</s1></fA20><fA21><s1>2013</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>20699</s2><s5>354000501942900060</s5></fA43><fA44><s0>0000</s0><s1>© 2013 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>67 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>13-0289629</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Breast cancer research and treatment</s0></fA64><fA66 i1="01"><s0>NLD</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B20E02</s0></fC02><fC02 i1="02" i2="X"><s0>002B12B04</s0></fC02><fC02 i1="03" i2="X"><s0>002B04C</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Seuil</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Threshold</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Umbral</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Cancer du sein</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Breast cancer</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Cáncer del pecho</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Lymphoedème</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Lymphedema</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Linfedema</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Bras</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Arm</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Brazo</s0><s5>04</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Facteur prédictif</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Predictive factor</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Factor predictivo</s0><s5>05</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Qualité de vie</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Quality of life</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Calidad vida</s0><s5>06</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Compression</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Compression</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Compresión</s0><s5>07</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Traitement</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Treatment</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Tratamiento</s0><s5>08</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Précoce</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Early</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Precoz</s0><s5>09</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Tumeur maligne</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Malignant tumor</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Tumor maligno</s0><s2>NM</s2><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Cancer</s0><s2>NM</s2></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Cancer</s0><s2>NM</s2></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Cáncer</s0><s2>NM</s2></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Pathologie de la glande mammaire</s0><s2>NM</s2><s5>38</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Mammary gland diseases</s0><s2>NM</s2><s5>38</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Glándula mamaria patología</s0><s2>NM</s2><s5>38</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie du sein</s0><s2>NM</s2><s5>39</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Breast disease</s0><s2>NM</s2><s5>39</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Seno patología</s0><s2>NM</s2><s5>39</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Pathologie de l'appareil circulatoire</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>40</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Pathologie des vaisseaux lymphatiques</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Lymphatic vessel disease</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Linfático patología</s0><s5>41</s5></fC07><fN21><s1>273</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard><server><NO>PASCAL 13-0289629 INIST</NO><ET>Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?</ET><AU>SPECHT (Michelle C.); MILLER (Cynthia L.); RUSSELL (Tara A.); HORICK (Nora); SKOLNY (Melissa N.); O'TOOLE (Jean A.); JAMMALLO (Lauren S.); NIEMIERKO (Andrzej); SADEK (Betro T.); SHENOUDA (Mina N.); FINKELSTEIN (Dianne M.); SMITH (Barbara L.); TAGHIAN (Alphonse G.)</AU><AF>Division of Surgical Oncology, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (1 aut., 12 aut.); Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (2 aut., 3 aut., 5 aut., 7 aut., 8 aut., 9 aut., 10 aut., 13 aut.); Department of Biostatistics, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (4 aut., 11 aut.); Department of Physical and Occupational Therapy, Massachusetts General Hospital, 100 Blossom Street/Boston, MA 02114/Etats-Unis (6 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>Breast cancer research and treatment; ISSN 0167-6806; Coden BCTRD6; Pays-Bas; Da. 2013; Vol. 140; No. 3; Pp. 485-494; Bibl. 67 ref.</SO><LA>Anglais</LA><EA>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.</EA><CC>002B20E02; 002B12B04; 002B04C</CC><FD>Seuil; Cancer du sein; Lymphoedème; Bras; Facteur prédictif; Qualité de vie; Compression; Traitement; Précoce</FD><FG>Tumeur maligne; Cancer; Pathologie de la glande mammaire; Pathologie du sein; Pathologie de l'appareil circulatoire; Pathologie des vaisseaux lymphatiques</FG><ED>Threshold; Breast cancer; Lymphedema; Arm; Predictive factor; Quality of life; Compression; Treatment; Early</ED><EG>Malignant tumor; Cancer; Mammary gland diseases; Breast disease; Cardiovascular disease; Lymphatic vessel disease</EG><SD>Umbral; Cáncer del pecho; Linfedema; Brazo; Factor predictivo; Calidad vida; Compresión; Tratamiento; Precoz</SD><LO>INIST-20699.354000501942900060</LO><ID>13-0289629</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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