Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer

Abstract

PurposeThe purpose of this study is to identify risk factors for transient lymphedema (TLE) and persistent lymphedema (PLE) following treatment for breast cancer.Materials and MethodsA total of 1,073 patients who underwent curative breast surgery were analyzed. TLE was defined as one episode of arm swelling that had resolved spontaneously by the next follow-up; arm swelling that persisted over two consecutive examinations was considered PLE.ResultsAt a median follow-up period of 5.1 years, 370 cases of lymphedema were reported, including 120 TLE (11.2%) and 250 PLE (23.3%). Initial grade 1 swelling was observed in 351 patients, of which 120 were limited to TLE (34%), while the other 231 progressed to PLE (66%). All initial swelling observed in TLE patients was classified as grade 1. In multivariate analysis, chemotherapy with taxane and supraclavicular radiation therapy (SCRT) were associated with development of TLE, whereas SCRT, stage III cancer and chemotherapy with taxane were identified as risk factors for PLE (p < 0.05). The estimated incidence of TLE among initial grade 1 patients was calculated using up to three treatment-related risk factors (number of dissected axillary lymph nodes, SCRT, and taxane chemotherapy). The approximate ratios of TLE and PLE based on the number of risk factors were 7:1 (no factor), 1:1 (one factor), 1:2 (two factors), and 1:3 (three factors).ConclusionOne-third of initial swelling events were transient, whereas the other two-thirds of patients experienced PLE. Estimation of TLE and PLE based on known treatment factors could facilitate prediction of this life-long complication.

Progressive resistance training to prevent arm lymphedema in the first year after breast cancer surgery: Results of a randomized controlled trial

“…Furthermore, the limited length of follow-up and the lack of interim measurements prevented differentiation between persistent and transient swelling, although the probability of transient swelling increases by only 2% after 1 year. 32 We would, however, expect additional cases of persistent lymphedema because the lymphedema incidence has been found to be 15% from 6 to 12 months after surgery and 19% from 12 to 24 months after surgery. 3 Lastly, the level of physical activity among the women who participated in this study was high, and this may limit the generalizability of the results to physically inactive women.…”

“…Pretreatment measurement would be preferable, but because the ALND procedure was not always known preoperatively, we did not consider this an option. Furthermore, the limited length of follow‐up and the lack of interim measurements prevented differentiation between persistent and transient swelling, although the probability of transient swelling increases by only 2% after 1 year . We would, however, expect additional cases of persistent lymphedema because the lymphedema incidence has been found to be 15% from 6 to 12 months after surgery and 19% from 12 to 24 months after surgery .…”

Lymphedema: From diagnosis to treatment

“…It is important to identify whether the swelling is transient or persistent. In one study, it was reported that one-third of initial swelling attacks were transient (10). Since effective treatment of LE can be established in early stages, accurate and timely diagnosis is crucial (11).…”

“…Although there is no unique sign or criteria for defining LE, the diagnosis is usually made clinically by thorough evaluation and physical examination (2,3,10). Family history is important in the diagnosis of primary LE.…”

Palliative surgery for giant mucinous carcinoma of the breast in an elderly patient: A rare case report

“…The incidence rate of postoperative complications such as pain, lymphedema, numbness or motility disorders differs between sentinel node biopsy and axillary lymph node dissection (16,17). It has been reported that chemotherapy with taxanes and radiation covering the breast and supraclavicular region were independent risk factors for lymphedema (18,19). Generally, MBC is potentially resistant to chemotherapy or radiotherapy (1,2,4).…”