Abstract
Several risk factors have been associated with upper extremity lymphedema after breast cancer treatment (LABC). These include mastectomy, axillary lymph node dissection (ALND), number of dissected and metastatic lymph nodes (NDN and NMN, respectively) and obesity. Despite the ongoing advances in breast cancer treatment, the need to study the secondary causes of lymphedema still exists due to its severe comorbidities. This study aims to identify risk factors for LABC, in particular axillary web syndrome (AWS). We conducted a prospective longitudinal study of women with unilateral breast cancer treated at our institution between 2011 and 2015. Lymphedema was diagnosed when there was a rise in upper limb circumference > 2 cm in comparison to the contralateral limb. Descriptive statistics were used to summarize and describe the data of independent variables. Survival analysis was used to analyse the time interval (days) between surgery and lymphedema diagnosis. We used the Kaplan-Meier method with log-rank test to compare survival curves between groups and Cox regression (proportional hazards regression) to analyze the effect of several risk factors on lymphedema diagnosis. An alpha of 0.05 was considered statistically significant. All statistical analyses were conducted using the Statistical Software SPSS version 24. Two hundred and thirty-one patients were included with a mean age of 56 years. Among patients, 18.6% had lymphedema, 65% underwent ALND, 26.4% had AWS and 13% had seroma. AWS was not associated with lymphedema ( P = 0.501). Variables significantly associated with lymphedema were Mastectomy (HR = 3.752; 95% CI: 1.156–12.177), ALND (HR = 0.025; 95% CI: 0.02–0.368), higher NDN (HR = 1.054; 95% CI: 1.019–1.091) and higher NMN (HR = 1.063; 95% CI: 1.014–1.115). Based on our results, AWS was not a risk factor for LABC. Unexpectedly, nor was ALND. This was probably due to the low NDN in many ALND, since a higher NDN did constitute a risk factor for LABC.
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