Natural History Of Breast Cancer-related Lymphedema
Stav Brown, MD, Joseph Dayan, MD MBA, Michelle Coriddi, MD, Lillian Boe, Phd, Andrea Barrio, MD, Babak J. Mehrara, MD.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Purpose: Although breast Cancer-related lymphedema (BCRL) is a chronic disease, the rate of progression is highly variable. The purpose of this prospective longitudinal study was to analyze the natural history of BCRL after axillary lymph node dissection (ALND) and identify predictive variables that may regulate the trajectory of the disease.
Methods: Between 2016 and 2020, 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 change (RVC) were recorded. Patients were divided into four disease trajectories based on RVC (no disease RVC<5%, mild RVC 5-10%, moderate RVC 10-20%, severe RVC>20%) and analyzed using an ordinal logistic regression model.
Results: 292 patients with a mean follow-up time of 32.7±6 months were included in the study. Lymphedema (defined as an RVC >5%) developed in 39.4% of patients, on average 14.6 months after surgery. Postoperative radiation therapy was the strongest predictor of severe disease trajectory (OR 8.98, 95% CI 1.68-167, p=0.007), followed by African American race (OR 2.16, 95% CI 1.15-4.03, p=0.011), older age (OR 1.03, 95% CI 1.00-1.05 p=0.02) and higher baseline volume differential (OR 0.94, 95% CI 0.89-0.94, p=0.014). Neither chemotherapy nor referral for lymphedema therapy/compression had a significant impact on the disease trajectory.
Conclusion: This is the largest prospective longitudinal study to identify predictive factors associated with severe BCRL disease trajectory. This information can be used to prioritize aggressive preventative measures such as immediate lymphatic reconstruction or immediate postoperative physical therapy
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