A Scoring System to Predict Arm Lymphedema Risk for Individual Chinese Breast Cancer Patients

Abstract

Background: Lymphedema (LE) is recognized as a common complication after axillary lymph node dissection (ALND). Numerous studies have attempted to identify risk factors for LE. However, it is difficult to predict the probability of LE for an individual patient. The purpose of this study was to construct a scoring system for predicting the probability of LE after ALND for Chinese breast cancer patients. Patients and Methods: 358 breast cancer patients were surveyed and followed for 12 months. LE was defined by circumferential measurement. Univariate and multivariate logistic regression analyses were used to screen risk factors of LE. Based on this, ß-coefficient of each risk factor was translated into a prognostic score and the scoring system was constructed. The area under the receiver operating characteristic curve (AUC) and calibration were calculated as an index for the predictive value of the scoring system. The model was internally validated using bootstrapping techniques. Results: The incidence rate of LE was 31.84%. Variables associated with LE and their corresponding score in the scoring system were: the level of ALND (level I = 0, level II = 1, level III = 2), history of hypertension (yes = 1, no = 0), surgery on dominant arm (yes = 1, no = 0), radiotherapy (yes = 2, no = 0), and surgical infection/seroma/early edema (yes = 2, no = 0). The probability of LE was predicted according to the total risk scores. The system had good discrimination, with an AUC at 0.877. If a cut-off value of 3 was used, the sensitivity was 81.20% and the specificity was 80.90%. An individual whose total risk score was higher than 3 was recognized as being at risk for LE. On internal validation, the bootstrap-corrected predictive accuracy was 0.798. The model demonstrated excellent calibration in the development set and internal validation. Conclusions: Our scoring system could be a simple and easy tool for physicians to estimate the risk of LE.

Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer-Related Lymphedema in Long-Term Breast Cancer Survivors

“…During hypertension, an elevated hydrostatic pressure in blood vessels increases capillary filtration between lymphatic and blood vessels. The continuous vicious cycle between the systems increases pressure and lymphatic flow, inducing lymphatic vessel hyperplasia and subsequently facilitating leakage of the lymph into the tissues, leading to swelling of the affected areas [49,50]. The association of hypertension as a risk factor affecting BCRL has yet to be elucidated as evidence on the correlation between hypertension and BCRL has been inconsistent, with some studies reporting a positive association [20,49,51] and others reporting no association [42,52].…”

Breast cancer‐related lymphoedema: Risk factors and prediction model

“…Basta et al, (2016) designed the Risk Assessment Tool Evaluating Lymphoedema, which focuses on women who undergo mastectomy. In the same year, Wang et al, (2016) 2020) reported a scoring system to predict the risk of BCRL that showed acceptable sensitivity and specificity. However, none of these scoring systems includes BMI as a potential factor because obesity is relatively uncommon in the populations studied, with a much lower incidence than in the case of European countries or the the importance of weight reduction as a preventive measure and support a more conservative surgical approach.…”

“…In order to analyse possible predictors of lymphoedema we recorded data for the five risk factors included in the scoring system developed by Wang et al, (2016). Namely the level of ALND (was defined according to Berg Levels [I, II or III]), radiotherapy (pre-operative, post-operative or no), surgery on the dominant arm, a history of hypertension and post-operative complications (as infection, seroma or suture dehiscence).…”

Sobrevivência e Fatores de Risco em Mulheres com Câncer de Mama: a Relação do Linfedema

“…A associação entre radioterapia e linfedema é frequentemente estudada. Neste estudo, a radioterapia na forma neoadjuvante se apresentou significante no grupo linfedema (p<0,0001), e demais estudos mostram que a radioterapia pode aumentar o risco de linfedema em 2,19 até 4.285 vezes 10,21 .…”