155. Lymphedema and Autoimmunity: Is There A Link?

Abstract

BACKGROUND: Despite the emerging evidence highlighting the role of immune responses in driving the progression of breast-cancer-related lymphedema (BCRL), there is a lack of data on the role of autoimmunity in lymphedema development. The purpose of this study was to investigate the association between a wide range of autoimmune diseases and lymphedema development after axillary lymph node dissection (ALND). METHODS: Patients who underwent ALND at our institution between 1995 and 2022 were included. Demographic data, lymphedema development after ALND, and the prevalence of autoimmune disorders were analyzed. RESULTS: 13,071 patients with a mean follow-up time of 88.4±59 months were included. Lymphedema developed in 1047 patients (8%). On univariate analysis, lymphedema development was significantly associated with one or more autoimmune diseases (OR 2.1, 95% CI 1.8-2.5, p<0.0001). The association was strongest for disorders involving the skin (OR 3.1, 95% CI 2.1-4.5, p<0.0001). These findings remained stable in multivariable analyses after adjustment for age, gender, race, BMI, radiation, and chemotherapy history. Preexisting diagnoses of atopic dermatitis (OR 8.5, 95% CI 4.0-17.8, p<0.0001), dermatopolymyositis (OR 4.0, 95% CI 1.2-12.5, p=0.0167), grave’s disease (OR 2.2, 95% CI 1.4-3.4, p=0.0004), vitiligo (OR 2.2, 95% CI 0.9-4.5, p=0.0437) and rheumatoid arthritis (OR 1.73, 95% CI 1.2-2.5, p=0.005) were highly predictive of lymphedema development following ALND. CONCLUSION: This is the first and largest study to date to investigate the association between autoimmune conditions and BCRL development. Our analysis demonstrated significant autoimmune comorbidity of patients with BCRL, suggesting that autoimmune reactions might play a role in the pathophysiology of BCRL development after ALND.