Breast cancer: NACT duration, BMI predict lymphedema

  • Armer JM & al.
  • JAMA Surg
  • 17 Jul 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Lymphedema in node-positive patients with breast cancer treated with axillary dissection is associated with 2 factors: neoadjuvant chemotherapy (NACT) duration of ≥144 days and BMI ≥30 kg/m2.

Why this matters

  • Authors recommend that women with these negative prognostic factors may benefit from enhanced prospective lymphedema surveillance.

Study design

  • Prospective cohort of 486 patients (cT0-T4N1-2M0) enrolled in the American College of Surgeons Oncology Group Z1071.
  • Lymphedema cumulative incidence at 3 years was defined as self-reported arm heaviness or swelling, or arm volume increase of ≥10% (V10) or ≥20% (V20).
  • Funding: NIH.

Key results

  • Median follow-up, 2.2-3.0 years.
  • At 3 years, cumulative lymphedema incidence was:
    • Lymphedema symptoms, 37.8% (95% CI, 33.1%-43.2%).
    • V10, 58.4% (95% CI, 53.2%-64.1%).
    • V20, 36.9% (95% CI, 31.9%-42.6%).
  • V10 incidence was greatest in patients with ≥30 nodes removed (HR, 1.70; 95% CI, 1.15-2.52) and increased with number of positive nodes (HR, 1.03; 95% CI, 1.00-1.06).
  • V20 incidence was higher among patients who received NACT for ≥144 days (HR, 1.79; 95% CI, 1.19-2.68).
  • In multivariate analysis:
    • Obesity ≥30 kg/m2 (vs 2) was associated with lymphedema symptoms (HR, 1.03; 95% CI, 1.01-1.06).
    • NACT duration ≥144 days (vs 105-143 days) was associated with V20 (HR, 1.74; 95% CI, 1.15-2.62).

Limitations

  • Observational design.

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