确定乳腺癌相关淋巴水肿 (BCRL) 的患病率和风险因素:淋巴水肿监测的实用方法

J. X. Hing, Yen Nee Chua, Pei Ting Tan, Meliza Su Ling Tan, C. Mok, Melissa Yert Li Seet, Zar Chi Lin, C. Seah, Wai Peng Lee, Su-Ming Tan
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简介:我们介绍了新加坡樟宜综合医院乳腺中心淋巴水肿监测策略的主要发现,该策略使用患者报告的症状、标准臂围测量值和临床评估来诊断乳腺癌相关淋巴水肿(BCRL)。我们的次要目的是强调和讨论可用于跟踪乳腺癌治疗结果的监测策略的重要因素,以利于今后的研究。研究方法我们对 511 名乳腺癌患者进行了横断面研究,以评估 BCRL 的患病率及其相关风险因素。我们根据患者的自我报告、客观臂围测量结果以及基于国际淋巴学会(ISL)分期的临床诊断来定义BCRL的患病率。结果显示患者的中位随访时间为 88.8 个月。队列中的累积患病率为 30.9%。BCRL患者的年龄较大(58.4岁对[vs] 54.9岁),平均体重指数较高(27.7对25.2),乳房切除术比例较高(77%对64.3%),腋窝清扫率较高,乳房重建的可能性较小、肿瘤等级较高、切除的淋巴结较多、结节病较晚期,并且接受过辅助化疗。然而,临床上明显的 BCRL 仅占 6.5%(511 例患者中有 33 例)。在接受前哨淋巴结活检(SLNB)或腋窝取样的患者中,有临床意义的BCRL比例为1.7%,而在接受腋窝清扫的患者中,这一比例为9.9%。大多数 BCRL 为亚临床或轻度。结论我们的研究表明,我国的淋巴水肿发生率与国际水平相当,并突出显示了类似的高风险患者特征。制定全面的淋巴水肿监测策略对于为今后的研究铺平道路至关重要。
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Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance
Introduction: We presented the key findings from Singapore’s Changi General Hospital Breast Centre’s lymphedema surveillance strategy that used patients’ reported symptoms, standard arm circumference measurements and clinical assessment in the diagnosis of breast cancer-related lymphedema (BCRL). Our secondary aim was to highlight and discuss important elements of a surveillance strategy that can be implemented to track this outcome measure of breast cancer treatment for future research. Method: We conducted a cross-sectional study of 511 breast cancer patients to assess the prevalence of BCRL and its associated risk factors. We defined BCRL prevalence rates based on patients’ self-reporting, objective arm circumference measure-ments and clinical diagnosis based on International Society of Lymphology (ISL) staging. Results: The median follow-up of patients was 88.8 months. The cumulative prevalence rate in the cohort was 30.9%. The cohort of BCRL patients were older (58.4 versus [vs] 54.9 years), had higher mean Body Mass Index (27.7 vs 25.2), higher proportion of mastectomy (77% vs 64.3%), axillary clearance, less likely breast reconstruction, higher-grade tumour, more lymph nodes excised, more advanced nodal disease, and had undergone adjuvant chemotherapy. However, clinically apparent BCRL was only 6.5% (33 out of 511 patients). The proportion of clinically significant BCRL in patients undergoing sentinel lymph node biopsy (SLNB) or axillary sampling was 1.7% compared to 9.9% in patients who had undergone axillary clearance. Majority of the BCRL were subclinical or mild in severity. Conclusion: Our study showed that our rates of BCRL were comparable to international rates and highlighted similar patient profiles who were at risk of developing the disease. Having a comprehensive lymphedema surveillance strategy is paramount in paving the way for future studies.
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