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Predicting The Progression Of Cancer-related Lymphedema: A Prospective Study
Stav Brown, MD, Lilian Boe, PhD, Michelle Coriddi, MD, Joseph Dayan, MD MBA, Andrea Barrio, MD, Babak Mehrara, MD
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Purpose: Breast cancer-related lymphedema (BCRL) has a highly variable disease progression. The purpose of this prospective longitudinal study was to identify variables that regulate disease progression after axillary lymph node dissection (ALND) and develop an algorithm to predict the course of arm volume changes over time.
Methods: We performed baseline arm volume measurements and prospectively followed patients who underwent ALND at a tertiary cancer-center every 6 months for 3 years. Demographic data and relative-volume-changes (RVCs) were recorded. A linear mixed-effects model (LMM) and a multiple linear regression model were formulated to identify variables associated with rapid increase in RVC over time. A generalized-estimating-equation approach was used to develop a prediction equation for continuous RVC measures.
Results: A total of 275 patients with a mean follow-up time of 37.6±4 months were included. Black race was the strongest predictor of rapid disease progression over time (β=0.12, 95% CI 0.04-0.20, p=0.003). Dominance of the affected arm acted as a protective factor (β =-0.08, 95% CI -0.15, -0.02, p=0.013). Neither neoadjuvant chemotherapy treatment, BMI, age, number of lymph nodes removed or referral for lymphedema therapy/compression had a significant impact on disease progression.
Conclusion: This is the largest prospective study to identify predictive variables associated with rapid BCRL progression and the first to provide a prediction algorithm for arm volumes over time. This information can be used to identify high-risk patients who might benefit from early preventative measures such as immediate-lymphatic-reconstruction at the time of ALND or early surgical intervention with lymphovenous-bypass or vascularized-lymph-node-transplantation.
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