Lancet Oncol：手术范围、超重或肥胖影响术后乳腺癌患者上臂淋巴水肿的发病率

在过去的几十年中，与乳腺癌相关的淋巴水肿的发病率和发病危险因素相关的证据得到了长足的发展，质量也有所改善。来自澳大利亚昆士兰科技大学的Tracey DiSipio等评估了乳腺癌术后单侧上臂淋巴水肿的发病率，以及探究了与淋巴水肿发生相关的可能危险因素，他们的研究结果发表在Lancet Oncol 3月的在线期刊上。
研究者检索的数据库为Academic Search Elite、Cumulative Index to Nursing and Allied Health、Cochrane Central Register of Controlled Trials和Medline，检索条件为发病率、危险因素、乳腺癌术后上臂淋巴水肿等，所检索的文献的发表时间为2000年1月1日至2012年6月30日。从检索到的文献中，研究者计算了发病率和相应的95%可信区间。研究者采用随机效应模型计算了总体淋巴水肿发病率，并进行了亚组分析以评估不同研究类型、开展研究的国家、诊断方法、至确诊所经历的时间和腋下淋巴结清扫程度等对研究结果的影响。同时，研究者也评估了导致淋巴水肿发生的危险因素，并根据研究结果的数量、质量和一致性等将危险因素分为四种不同的强度的证据类型。
共有72个研究符合研究者的纳入标准被用于评估淋巴水肿的发病率——总体发病率约为16.6%，95%可信区间为13.6%至20.2%。当研究者仅将30个前瞻性研究的结果纳入评估后总体发病率为21.4%，95%可信区间为14.9%至29.8%。研究者指出上臂淋巴水肿的发病率似乎在确诊或乳腺癌术后2年时有所增加，当采用多种诊断方式对淋巴水肿进行确诊时总体发病率最高，与仅接受哨兵淋巴结活检的患者相比，接受腋窝淋巴结清扫术的女性患者淋巴水肿的总体发病率可增高4倍。有29个研究符合研究者的纳入标准被用于淋巴水肿发病危险因素的评估。危险因素包括：手术范围广泛（如腋窝淋巴结清扫术、切除多枚淋巴结和乳房切除术）和超重或肥胖。
本研究结果提示在乳腺癌的幸存患者中，每5人中就至少有1人会出现上臂淋巴水肿。由于淋巴水肿可能造成患者残疾和造成患者情绪障碍，所以我们需要改善对于淋巴水肿发病危险因素的认识，以及注重对淋巴水肿发病的预防和治疗以降低患者个人和公共卫生的负担。
与乳腺癌相关的拓展阅读：

• JNCI：雌激素联合黄体酮会增高乳腺癌发病率
• JNCI：高脂饮食增加乳腺癌患者死亡率
• NCCN 2013：乳腺癌临床实践指南（2013.V1）
• JNCI：Ran表达或影响乳腺癌和肺癌患者的生存期
• J Clin Oncol：拉帕替尼一线解救提高乳腺癌生存
• NEJM: 乳腺癌放疗增加缺血性心脏病风险
更多信息请点击：有关乳腺癌更多资讯

Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis
Background
The body of evidence related to breast-cancer-related lymphoedema incidence and risk factors has substantially grown and improved in quality over the past decade. We assessed the incidence of unilateral arm lymphoedema after breast cancer and explored the evidence available for lymphoedema risk factors.
Methods
We searched Academic Search Elite, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials (clinical trials), and Medline for research articles that assessed the incidence or prevalence of, or risk factors for, arm lymphoedema after breast cancer, published between Jan 1, 2000, and June 30, 2012. We extracted incidence data and calculated corresponding exact binomial 95% CIs. We used random effects models to calculate a pooled overall estimate of lymphoedema incidence, with subgroup analyses to assess the effect of different study designs, countries of study origin, diagnostic methods, time since diagnosis, and extent of axillary surgery. We assessed risk factors and collated them into four levels of evidence, depending on consistency of findings and quality and quantity of studies contributing to findings.
Findings
72 studies met the inclusion criteria for the assessment of lymphoedema incidence, giving a pooled estimate of 16·6% (95% CI 13·6—20·2). Our estimate was 21·4% (14·9—29·8) when restricted to data from prospective cohort studies (30 studies). The incidence of arm lymphoedema seemed to increase up to 2 years after diagnosis or surgery of breast cancer (24 studies with time since diagnosis or surgery of 12 to <24 months; 18·9%, 14·2—24·7), was highest when assessed by more than one diagnostic method (nine studies; 28·2%, 11·8—53·5), and was about four times higher in women who had an axillary-lymph-node dissection (18 studies; 19·9%, 13·5—28·2) than it was in those who had sentinel-node biopsy (18 studies; 5·6%, 6·1—7·9). 29 studies met the inclusion criteria for the assessment of risk factors. Risk factors that had a strong level of evidence were extensive surgery (ie, axillary-lymph-node dissection, greater number of lymph nodes dissected, mastectomy) and being overweight or obese.