Breast Cancer–Related Lymphedema after Neoadjuvant Chemotherapy
Identifieur interne : 000324 ( Pmc/Curation ); précédent : 000323; suivant : 000325Breast Cancer–Related Lymphedema after Neoadjuvant Chemotherapy
Auteurs : Myungsoo Kim [Corée du Sud] ; In Hae Park [Corée du Sud] ; Keun Seok Lee [Corée du Sud] ; Jungsil Ro [Corée du Sud] ; So-Youn Jung [Corée du Sud] ; Seeyoun Lee [Corée du Sud] ; Han-Sung Kang [Corée du Sud] ; Eun Sook Lee [Corée du Sud] ; Tae Hyun Kim [Corée du Sud] ; Kwan Ho Cho [Corée du Sud] ; Kyung Hwan Shin [Corée du Sud]Source :
- Cancer Research and Treatment : Official Journal of Korean Cancer Association [ 1598-2998 ] ; 2014.
Abstract
The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT.
A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database.
At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE.
LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up.
Url:
DOI: 10.4143/crt.2014.079
PubMed: 25544575
PubMed Central: 4506114
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Park</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Keun Seok" sort="Lee, Keun Seok" uniqKey="Lee K" first="Keun Seok" last="Lee">Keun Seok Lee</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Ro, Jungsil" sort="Ro, Jungsil" uniqKey="Ro J" first="Jungsil" last="Ro">Jungsil Ro</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country 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National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Cho, Kwan Ho" sort="Cho, Kwan Ho" uniqKey="Cho K" first="Kwan Ho" last="Cho">Kwan Ho Cho</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Shin, Kyung Hwan" sort="Shin, Kyung Hwan" uniqKey="Shin K" first="Kyung Hwan" last="Shin">Kyung Hwan Shin</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country 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Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2-crt-2014-079">Department of Radiation Oncology, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Park, In Hae" sort="Park, In Hae" uniqKey="Park I" first="In Hae" last="Park">In Hae Park</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Keun Seok" sort="Lee, Keun Seok" uniqKey="Lee K" first="Keun Seok" last="Lee">Keun Seok Lee</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Ro, Jungsil" sort="Ro, Jungsil" uniqKey="Ro J" first="Jungsil" last="Ro">Jungsil Ro</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Jung, So Youn" sort="Jung, So Youn" uniqKey="Jung S" first="So-Youn" last="Jung">So-Youn Jung</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Seeyoun" sort="Lee, Seeyoun" uniqKey="Lee S" first="Seeyoun" last="Lee">Seeyoun Lee</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Kang, Han Sung" sort="Kang, Han Sung" uniqKey="Kang H" first="Han-Sung" last="Kang">Han-Sung Kang</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Eun Sook" sort="Lee, Eun Sook" uniqKey="Lee E" first="Eun Sook" last="Lee">Eun Sook Lee</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Tae Hyun" sort="Kim, Tae Hyun" uniqKey="Kim T" first="Tae Hyun" last="Kim">Tae Hyun Kim</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Cho, Kwan Ho" sort="Cho, Kwan Ho" uniqKey="Cho K" first="Kwan Ho" last="Cho">Kwan Ho Cho</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Shin, Kyung Hwan" sort="Shin, Kyung Hwan" uniqKey="Shin K" first="Kyung Hwan" last="Shin">Kyung Hwan Shin</name><affiliation wicri:level="1"><nlm:aff id="af1-crt-2014-079">Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Cancer Research and Treatment : Official Journal of Korean Cancer Association</title><idno type="ISSN">1598-2998</idno><idno type="eISSN">2005-9256</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT.</p></sec><sec><title>Materials and Methods</title><p>A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database.</p></sec><sec><title>Results</title><p>At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE.</p></sec><sec><title>Conclusion</title><p>LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Disipio, T" uniqKey="Disipio T">T DiSipio</name></author><author><name sortKey="Rye, S" uniqKey="Rye S">S Rye</name></author><author><name sortKey="Newman, B" uniqKey="Newman B">B Newman</name></author><author><name sortKey="Hayes, S" uniqKey="Hayes S">S Hayes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, M" uniqKey="Kim M">M Kim</name></author><author><name sortKey="Kim, Sw" uniqKey="Kim S">SW Kim</name></author><author><name sortKey="Lee, Su" uniqKey="Lee S">SU Lee</name></author><author><name sortKey="Lee, Nk" uniqKey="Lee N">NK Lee</name></author><author><name sortKey="Jung, Sy" uniqKey="Jung S">SY Jung</name></author><author><name sortKey="Kim, Th" uniqKey="Kim T">TH 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Cancer Res Treat</journal-id><journal-id journal-id-type="iso-abbrev">Cancer Res Treat</journal-id><journal-id journal-id-type="publisher-id">CRT</journal-id><journal-title-group><journal-title>Cancer Research and Treatment : Official Journal of Korean Cancer Association</journal-title></journal-title-group><issn pub-type="ppub">1598-2998</issn><issn pub-type="epub">2005-9256</issn><publisher><publisher-name>Korean Cancer Association</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25544575</article-id><article-id pub-id-type="pmc">4506114</article-id><article-id pub-id-type="doi">10.4143/crt.2014.079</article-id><article-id pub-id-type="publisher-id">crt-2014-079</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Breast Cancer–Related Lymphedema after Neoadjuvant Chemotherapy</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Myungsoo</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref><xref ref-type="aff" rid="af2-crt-2014-079"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Park</surname><given-names>In Hae</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Keun Seok</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ro</surname><given-names>Jungsil</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jung</surname><given-names>So-Youn</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Seeyoun</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kang</surname><given-names>Han-Sung</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Eun Sook</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Tae Hyun</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cho</surname><given-names>Kwan Ho</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Shin</surname><given-names>Kyung Hwan</given-names></name><degrees>MD</degrees><degrees>PhD</degrees><xref ref-type="corresp" rid="c1-crt-2014-079"></xref><xref ref-type="aff" rid="af1-crt-2014-079"><sup>1</sup></xref></contrib><aff id="af1-crt-2014-079"><label>1</label>Research Institute and Hospital, National Cancer Center, Goyang,<country>Korea</country></aff><aff id="af2-crt-2014-079"><label>2</label>Department of Radiation Oncology, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul,<country>Korea</country></aff></contrib-group><author-notes><corresp id="c1-crt-2014-079">Correspondence: Kyung Hwan Shin, MD, PhD Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10-769, Korea Tel: 82-31-920-1722 Fax: 82-31-920-0149 E-mail: <email>radiat@ncc.re.kr</email></corresp></author-notes><pub-date pub-type="ppub"><month>7</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>17</day><month>11</month><year>2014</year></pub-date><volume>47</volume><issue>3</issue><fpage>416</fpage><lpage>423</lpage><history><date date-type="received"><day>25</day><month>3</month><year>2014</year></date><date date-type="accepted"><day>1</day><month>5</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2015 by the Korean Cancer Association</copyright-statement><copyright-year>2015</copyright-year><license><license-p>This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Purpose</title><p>The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT.</p></sec><sec><title>Materials and Methods</title><p>A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database.</p></sec><sec><title>Results</title><p>At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE.</p></sec><sec><title>Conclusion</title><p>LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up.</p></sec></abstract><kwd-group><kwd>Breast neoplasms</kwd><kwd>Lymphedema</kwd><kwd>Neoadjuvant chemotherapy</kwd><kwd>Risk factors</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-crt-2014-079" orientation="portrait" position="float"><label>Fig. 1.</label><caption><p>Kaplan-Meier plots of the cumulative incidence of breast cancer–related lymphedema.</p></caption><graphic xlink:href="crt-2014-079f1"></graphic></fig><fig id="f2-crt-2014-079" orientation="portrait" position="float"><label>Fig. 2.</label><caption><p>Kaplan-Meier plots of the cumulative rates of breast cancer–related lymphedema in accordance to the number of risk factors (age ≥ 50 years and > 10 dissected axillary nodes).</p></caption><graphic xlink:href="crt-2014-079f2"></graphic></fig><table-wrap id="t1-crt-2014-079" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Patient characteristics and treatment information (n=313)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Characteristic</th><th align="center" valign="middle" rowspan="1" colspan="1">Classification</th><th align="center" valign="middle" rowspan="1" colspan="1">No. of patients (%)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (yr)</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">46 (26-76)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Body mass index (kg/m<sup>2</sup>)</td><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="center" valign="top" rowspan="1" colspan="1">24 (17-36)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ypT classification</td><td align="left" valign="top" rowspan="1" colspan="1">T0</td><td align="center" valign="top" rowspan="1" colspan="1">54 (17)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">T1</td><td align="center" valign="top" rowspan="1" colspan="1">127 (41)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">T2</td><td align="center" valign="top" rowspan="1" colspan="1">97 (31)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">T3-4</td><td align="center" valign="top" rowspan="1" colspan="1">35 (11)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ypN classification</td><td align="left" valign="top" rowspan="1" colspan="1">N0</td><td align="center" valign="top" rowspan="1" colspan="1">97 (31)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">N1</td><td align="center" valign="top" rowspan="1" colspan="1">103 (33)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">N2-3</td><td align="center" valign="top" rowspan="1" colspan="1">113 (36)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ypStage</td><td align="left" valign="top" rowspan="1" colspan="1">pCR</td><td align="center" valign="top" rowspan="1" colspan="1">50 (16)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">I-II</td><td align="center" valign="top" rowspan="1" colspan="1">142 (45)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">III</td><td align="center" valign="top" rowspan="1" colspan="1">121 (39)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Type of surgery</td><td align="left" valign="top" rowspan="1" colspan="1">Breast-conserving surgery</td><td align="center" valign="top" rowspan="1" colspan="1">219 (70)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Mastectomy</td><td align="center" valign="top" rowspan="1" colspan="1">94 (30)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">No. of dissected axillary nodes</td><td align="left" valign="top" rowspan="1" colspan="1">5-10</td><td align="center" valign="top" rowspan="1" colspan="1">108 (35)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">11-20</td><td align="center" valign="top" rowspan="1" colspan="1">169 (54)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">≥ 21</td><td align="center" valign="top" rowspan="1" colspan="1">36 (11)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Chemotherapy</td><td align="left" valign="top" rowspan="1" colspan="1">Neoadjuvant only</td><td align="center" valign="top" rowspan="1" colspan="1">133 (42)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Neoadjuvant and adjuvant</td><td align="center" valign="top" rowspan="1" colspan="1">180 (58)</td></tr></tbody></table><table-wrap-foot><fn><p>Values are presented as median (range) or number (%). pCR, pathologic complete response.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t2-crt-2014-079" orientation="portrait" position="float"><label>Table 2.</label><caption><p>Univariate analysis of risk factors associated with breast cancer–related lymphedema</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="middle" rowspan="2" colspan="1">Variable</th><th align="center" valign="middle" rowspan="2" colspan="1">Classification</th><th align="center" valign="middle" colspan="2" rowspan="1">No. of patients<hr></hr></th><th align="center" valign="middle" rowspan="2" colspan="1">p-value<xref rid="tfn1-crt-2014-079" ref-type="table-fn"><sup>a)</sup></xref></th></tr><tr><th align="center" valign="middle" rowspan="1" colspan="1">Total</th><th align="center" valign="middle" rowspan="1" colspan="1">Lymphedema (%)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (yr)</td><td align="left" valign="top" rowspan="1" colspan="1">< 50</td><td align="center" valign="top" rowspan="1" colspan="1">214</td><td align="center" valign="top" rowspan="1" colspan="1">81 (38)</td><td align="center" valign="top" rowspan="1" colspan="1">0.01</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">≥ 50</td><td align="center" valign="top" rowspan="1" colspan="1">99</td><td align="center" valign="top" rowspan="1" colspan="1">51 (52)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Body mass index (kg/m<sup>2</sup>)</td><td align="left" valign="top" rowspan="1" colspan="1">< 25</td><td align="center" valign="top" rowspan="1" colspan="1">213</td><td align="center" valign="top" rowspan="1" colspan="1">84 (39)</td><td align="center" valign="top" rowspan="1" colspan="1">0.13</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">≥ 25</td><td align="center" valign="top" rowspan="1" colspan="1">100</td><td align="center" valign="top" rowspan="1" colspan="1">48 (48)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ypT classification</td><td align="left" valign="top" rowspan="1" colspan="1">T0-1</td><td align="center" valign="top" rowspan="1" colspan="1">181</td><td align="center" valign="top" rowspan="1" colspan="1">75 (41)</td><td align="center" valign="top" rowspan="1" colspan="1">0.72</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">T2-4</td><td align="center" valign="top" rowspan="1" colspan="1">132</td><td align="center" valign="top" rowspan="1" colspan="1">57 (43)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ypN classification</td><td align="left" valign="top" rowspan="1" colspan="1">N0-1</td><td align="center" valign="top" rowspan="1" colspan="1">200</td><td align="center" valign="top" rowspan="1" colspan="1">77 (39)</td><td align="center" valign="top" rowspan="1" colspan="1">0.08</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">N2-3</td><td align="center" valign="top" rowspan="1" colspan="1">113</td><td align="center" valign="top" rowspan="1" colspan="1">55 (49)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">ypStage</td><td align="left" valign="top" rowspan="1" colspan="1">pCR, I-II</td><td align="center" valign="top" rowspan="1" colspan="1">192</td><td align="center" valign="top" rowspan="1" colspan="1">73 (38)</td><td align="center" valign="top" rowspan="1" colspan="1">0.053</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">III</td><td align="center" valign="top" rowspan="1" colspan="1">121</td><td align="center" valign="top" rowspan="1" colspan="1">59 (49)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Type of surgery</td><td align="left" valign="top" rowspan="1" colspan="1">Breast-conserving surgery</td><td align="center" valign="top" rowspan="1" colspan="1">219</td><td align="center" valign="top" rowspan="1" colspan="1">86 (39)</td><td align="center" valign="top" rowspan="1" colspan="1">0.08</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Mastectomy</td><td align="center" valign="top" rowspan="1" colspan="1">94</td><td align="center" valign="top" rowspan="1" colspan="1">46 (49)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">No. of dissected axillary nodes</td><td align="left" valign="top" rowspan="1" colspan="1">≤ 10</td><td align="center" valign="top" rowspan="1" colspan="1">108</td><td align="center" valign="top" rowspan="1" colspan="1">35 (32)</td><td align="center" valign="top" rowspan="1" colspan="1">0.03</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">> 10</td><td align="center" valign="top" rowspan="1" colspan="1">205</td><td align="center" valign="top" rowspan="1" colspan="1">97 (47)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Chemotherapy</td><td align="left" valign="top" rowspan="1" colspan="1">Neoadjuvant only</td><td align="center" valign="top" rowspan="1" colspan="1">133</td><td align="center" valign="top" rowspan="1" colspan="1">58 (44)</td><td align="center" valign="top" rowspan="1" colspan="1">0.61</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Neoadjuvant and adjuvant</td><td align="center" valign="top" rowspan="1" colspan="1">180</td><td align="center" valign="top" rowspan="1" colspan="1">74 (41)</td><td align="center" valign="top" rowspan="1" colspan="1"></td></tr></tbody></table><table-wrap-foot><fn><p>pCR, pathologic complete response.</p></fn><fn id="tfn1-crt-2014-079"><label>a)</label><p>Cox proportional hazards model.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-crt-2014-079" orientation="portrait" position="float"><label>Table 3.</label><caption><p>Multivariate analysis of risk factors associated with breast cancer–related lymphedema</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="middle" rowspan="1" colspan="1">Variable</th><th align="center" valign="middle" rowspan="1" colspan="1">Hazard ratio (95% CI)</th><th align="center" valign="middle" rowspan="1" colspan="1">p-value<xref rid="tfn2-crt-2014-079" ref-type="table-fn"><sup>a)</sup></xref></th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (< 50 yr vs. ≥ 50 yr)</td><td align="center" valign="top" rowspan="1" colspan="1">1.66 (1.16-2.36)</td><td align="center" valign="top" rowspan="1" colspan="1">< 0.01</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">No. of dissected axillary nodes (≤ 10 vs. > 10)</td><td align="center" valign="top" rowspan="1" colspan="1">1.68 (1.14-2.48)</td><td align="center" valign="top" rowspan="1" colspan="1">< 0.01</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Type of surgery (breast conserving surgery vs. mastectomy)</td><td align="center" valign="top" rowspan="1" colspan="1">1.42 (0.99-2.04)</td><td align="center" valign="top" rowspan="1" colspan="1">0.056</td></tr></tbody></table><table-wrap-foot><fn><p>CI, confidence interval.</p></fn><fn id="tfn2-crt-2014-079"><label>a)</label><p>Cox proportional hazards model.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t4-crt-2014-079" orientation="portrait" position="float"><label>Table 4.</label><caption><p>Five-year rate of breast cancer.related lymphedema according to the number of risk factors</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="middle" rowspan="2" colspan="1">No. of risk factors</th><th align="center" valign="middle" colspan="2" rowspan="1">Risk factor<hr></hr></th><th align="center" valign="middle" rowspan="2" colspan="1">No.</th><th align="center" valign="middle" rowspan="2" colspan="1">Five-year lymphedema rate (%)</th><th align="center" valign="middle" rowspan="2" colspan="1">p-value<xref rid="tfn3-crt-2014-079" ref-type="table-fn"><sup>a)</sup></xref></th></tr><tr><th align="center" valign="middle" rowspan="1" colspan="1">Age (yr)</th><th align="center" valign="middle" rowspan="1" colspan="1">N-ALN</th></tr></thead><tbody><tr><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1">< 50</td><td align="center" valign="top" rowspan="1" colspan="1">≤ 10</td><td align="center" valign="top" rowspan="1" colspan="1">71</td><td align="center" valign="top" rowspan="1" colspan="1">31</td><td align="center" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="center" valign="top" rowspan="1" colspan="1">1</td><td align="center" valign="top" rowspan="1" colspan="1">≥ 50</td><td align="center" valign="top" rowspan="1" colspan="1">≤ 10</td><td align="center" valign="top" rowspan="1" colspan="1">37</td><td align="center" valign="top" rowspan="1" colspan="1">35</td><td align="center" valign="top" rowspan="1" colspan="1">0.69</td></tr><tr><td align="center" valign="top" rowspan="1" colspan="1">1</td><td align="center" valign="top" rowspan="1" colspan="1">< 50</td><td align="center" valign="top" rowspan="1" colspan="1">> 10</td><td align="center" valign="top" rowspan="1" colspan="1">143</td><td align="center" valign="top" rowspan="1" colspan="1">41</td><td align="center" valign="top" rowspan="1" colspan="1">0.24</td></tr><tr><td align="center" valign="top" rowspan="1" colspan="1">2</td><td align="center" valign="top" rowspan="1" colspan="1">≥ 50</td><td align="center" valign="top" rowspan="1" colspan="1">> 10</td><td align="center" valign="top" rowspan="1" colspan="1">62</td><td align="center" valign="top" rowspan="1" colspan="1">61</td><td align="center" valign="top" rowspan="1" colspan="1">0.001</td></tr></tbody></table><table-wrap-foot><fn><p>N-ALN, number of dissected axillary lymph nodes</p></fn><fn id="tfn3-crt-2014-079"><label>a)</label><p>Log-rank test; p-values were determined vs. 0 risk factors.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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