D84. Pre-operative Lymphedema Risk Factors in Patients with Inflammatory Breast Cancer: Optimizing Patient Selection for LYMPHA

Abstract

PURPOSE: LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) is increasingly offered for prevention of upper extremity lymphedema after breast cancer treatment, which develops in up to 47% of breast cancer patients. Prior studies have focused on intraoperative and postoperative lymphedema risk factors. This study aimed to identify preoperative risk factors, when the decision to perform LYMPHA must be made. METHODS: Retrospective review of a dedicated inflammatory breast cancer (IBC) program database was conducted. The primary outcome was self-reported lymphedema development. Multivariable logistic regression analysis was performed to identify preoperative lymphedema risk factors, while controlling for number of lymph nodes removed during axillary lymph node dissection (ALND), number of positive lymph nodes, residual disease on final pathology, and need for adjuvant chemotherapy. RESULTS: Of 356 patients with IBC, 134 (mean age 51 years, range 22-89 years) had complete data. Forty-seven percent developed lymphedema. Obesity (BMI>30) (OR 2.7, CI 1.2-6.4, p=0.02) and non-white race (OR 4.5, CI 1.2-23, p=0.04) were preoperative risk factors for lymphedema development. CONCLUSION: Patients with IBC are at high risk for developing lymphedema, due to their need for ALND, radiation, and neoadjuvant chemotherapy. This study identified non-white race and obesity as additional risk factors. Due to the high prevalence of lymphedema, LYMPHA should be considered for all patients with inflammatory breast cancer. Larger prospective studies should evaluate potential racial disparities in lymphedema development.