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Comparative Study
. 2015 Dec;112(8):834-40.
doi: 10.1002/jso.24068. Epub 2015 Oct 18.

The long-term risk of upper-extremity lymphedema is two-fold higher in breast cancer patients than in melanoma patients

Rachel K Voss  1 , Kate D Cromwell  1 , Yi-Ju Chiang  1 , Jane M Armer  2 , Merrick I Ross  1 , Jeffrey E Lee  1 , Jeffrey E Gershenwald  1 , Bob R Stewart  2 , Simona F Shaitelman  3 , Janice N Cormier  1
Affiliations
Comparative Study

The long-term risk of upper-extremity lymphedema is two-fold higher in breast cancer patients than in melanoma patients

Rachel K Voss et al. J Surg Oncol. 2015 Dec.

Abstract

Background and objectives: We assessed the cumulative incidence, symptoms, and risk factors for upper-extremity lymphedema in breast cancer and melanoma patients undergoing sentinel lymph node biopsy or axillary lymph node dissection.

Methods: Patients were recruited preoperatively (time 0) and assessed at 6, 12, and 18 months postoperatively. Limb volume change (LVC) was measured by perometry. Lymphedema was categorized as none, mild (LVC 5-9.9%), or moderate/severe (LVC≥10%). Symptoms were assessed with a validated lymphedema instrument. Longitudinal logistic regression analyses were conducted to identify risk factors associated with moderate/severe lymphedema.

Results: Among 205 breast cancer and 144 melanoma patients, the cumulative incidence of moderate/severe lymphedema at 18 months was 36.5% and 35.0%, respectively. However, in adjusted analyses, factors associated with moderate/severe lymphedema were breast cancer (OR 2.0, P = 0.03), body mass index ≥ 30 kg/m(2) (OR 1.6, P = 0.04), greater number of lymph nodes removed (OR 1.05, P < 0.01), and longer interval since surgery (OR 2.33 at 18 months, P < 0.01).

Conclusions: Lymphedema incidence increased over time in both cohorts. However, the adjusted risk of moderate/severe lymphedema was two-fold higher in breast cancer patients. These results may be attributed to surgical treatment of the primary tumor in the breast and more frequent use of radiation.

Keywords: breast cancer; lymph node excision; lymphedema; melanoma.

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Figures

Figure 1
Figure 1
Cumulative incidences of A) mild lymphedema and B) moderate/severe lymphedema at 6, 12, and 18 months stratified by type of surgery for breast cancer and melanoma patients. The cumulative incidence of mild lymphedema is higher in breast cancer patients and relatively stable over time. Moderate/severe lymphedema increases over time in both groups and is highest for melanoma patients after ALND. SLNB = Sentinel Lymph Node Biopsy, ALND = Axillary Lymph Node Dissection
Figure 2
Figure 2
Forest plot of longitudinal logistic regression model showing longer interval since surgery, breast cancer, BMI≥30 kg/m2, and greater number of lymph nodes removed to be significant factors for development of moderate/severe lymphedema. LN = Lymph Node, BMI = Body Mass Index, SLNB = Sentinel Lymph Node Biopsy, ALND = Axillary Lymph Node Dissection
Figure 3
Figure 3
Radar plots of the most commonly reported symptoms at 12 months for A) breast cancer and B) melanoma patients. The frequency of reported symptoms was similar for breast cancer patients with lymphedema, but in melanoma, symptoms increased with worsening lymphedema. LE = lymphedema, LVC = limb volume change
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29. - PubMed
    1. Hyngstrom JR, et al. Prospective assessment of lymphedema incidence and lymphedema-associated symptoms following lymph node surgery for melanoma. Melanoma Res. 2013;23(4):290–7. - PMC - PubMed
    1. Cormier JN, et al. Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related secondary lymphedema. Cancer. 2010;116(22):5138–49. - PubMed
    1. de Vries M, et al. Morbidity after axillary sentinel lymph node biopsy in patients with cutaneous melanoma. Eur J Surg Oncol. 2005;31(7):778–83. - PubMed
    1. Starritt EC, et al. Lymphedema after complete axillary node dissection for melanoma: assessment using a new, objective definition. Ann Surg. 2004;240(5):866–74. - PMC - PubMed

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