摘要
目的 了解乳腺癌患者放疗后上肢淋巴水肿的发生情况,并分析其相关的危险因素.方法 回顾性分析2007年至2012年间92例于我科接受术后辅助放疗的乳腺癌患者临床资料,对其上肢淋巴水肿进行评估；主观症状采用FCAT-B ＋4量表,客观体征采用对双侧手臂肩峰端下15c m和尺骨鹰嘴下15cm处进行周径测量的方法,分别计算两种评估方法的上肢淋巴水肿发生率；用卡方检验及Logistic回归分析其发生的危险因素.结果 主观症状及客观体征检查中上肢淋巴水肿发生率分别为53.3％和32.6％.客观体征检查发现锁骨上区照射组和未照射组上肢淋巴水肿发生率分别为37.8％和11.1％ （P=0.030）,腋窝淋巴结阳性组和阴性组分别为41.5％和11.1％ （P =0.005）,Ⅲ期组和0～Ⅱ期组分别为52.5％和17.3％ （P =0.000）.多因素分析显示术后TNM分期是上肢淋巴水肿的独立危险因素.结论 上肢淋巴水肿是乳腺癌术后放疗的常见并发症,锁骨上区照射、腋窝淋巴结阳性及术后分期较晚是上肢淋巴水肿的危险因素.
Objective To identify the rates of breast cancer-related lymphedema （BCRL） induced by radiotherapy in patients after breast surgery and to analyze the relative risk factors contributing to BCRL.Methods A total of 92 patients with breast cancer were treated with lumpectomy or modified radical mastectomy and afterwards conformal radiotherapy in our hospital.The determination of BCRL was based on subjective symptoms felt by patients and objective signs viewed by medical personnels.FCAT-B ＋4 scoring system was introduced to comment patients＇ symptoms and circumference measurement was taken at 15 cm below the acromion process and 15 cm below the olecranon in both arms.Then the actuarial rates of BCRL were calculated.Univariate analysis was performed by ChiSquare test,and multivariable analysis was undertaken by binary logistic regression.Results The actuarial rate of complaint and positive physical finding of BCRL was respectively 53.3％ and 32.6％,among which BCRL was more likely to develop in patients with advanced nodal status （41.5 ％ vs.11.1％,P =0.005）,patients with stage Ⅲ （52.5 ％ vs.17.3 ％,P =0.000）,and patients receiving supraclavicular irradiation （37.8％ vs.11.1％,P =0.030）.TNM stage was the independent risk factor leading to lymphedema after multivariable analysis.Conclusion BCRL is the common complication with high morbidity induced by postoperative radiotherapy.The risk factors of BCRL include advanced nodal status,late stage and supraclavicular irradiation.
出处
《临床肿瘤学杂志》
CAS
2013年第10期905-909,共5页
Chinese Clinical Oncology
基金
江苏省卫生厅科研资助项目(Z201305)
