Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?
Identifieur interne : 001987 ( PubMed/Curation ); précédent : 001986; suivant : 001988Defining 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 ; 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 [ 1573-7217 ] ; 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.
- Adulte, Adulte d'âge moyen, Analyse multivariée, Facteurs temps, Femelle, Humains, Jeune adulte, Modèles de hasards proportionnels, Période postopératoire, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein, Études prospectives, Évolution de la maladie.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Arm (physiopathology), Breast Neoplasms (complications), Breast Neoplasms (pathology), Breast Neoplasms (surgery), Breast Neoplasms (therapy), Disease Progression, Female, Humans, Lymph Node Excision (adverse effects), Lymphedema (epidemiology), Lymphedema (etiology), Lymphedema (pathology), Mastectomy (adverse effects), Middle Aged, Multivariate Analysis, Postoperative Period, Proportional Hazards Models, Prospective Studies, Time Factors, 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.
DOI: 10.1007/s10549-013-2655-2
PubMed: 23912961
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<term>Breast Neoplasms (complications)</term>
<term>Breast Neoplasms (pathology)</term>
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<term>Breast Neoplasms (therapy)</term>
<term>Disease Progression</term>
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<term>Facteurs temps</term>
<term>Femelle</term>
<term>Humains</term>
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<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Breast Neoplasms</term>
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<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Lymphoedème</term>
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<term>Aged, 80 and over</term>
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<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>
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<Title>Breast cancer research and treatment</Title>
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<ArticleTitle>Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression?</ArticleTitle>
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<Abstract><AbstractText>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.</AbstractText>
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<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Specht</LastName>
<ForeName>Michelle C</ForeName>
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<ForeName>Tara A</ForeName>
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