Breast cancer-related lymphedema: A comprehensive analysis of risk factors

Charalampos Siotos; Sydney H Arnold; Michelle Seu; Lilia Lunt; Jennifer Ferraro; Daniel Najafali; George Damoulakis; Joshua Vorstenbosch; Babak J Mehrara; Anuja K Antony; Deana S Shenaq; George Kokosis

doi:10.1002/jso.27841

Breast cancer-related lymphedema: A comprehensive analysis of risk factors

J Surg Oncol. 2024 Aug 27. doi: 10.1002/jso.27841. Online ahead of print.

Authors

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois, USA.
² Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA.
³ Department of Surgery, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
⁴ Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois, USA.
⁵ Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
⁶ Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

PMID: 39190469
DOI: 10.1002/jso.27841

Abstract

Background: Breast cancer-related lymphedema is a devastating condition that negatively affects the quality of life of breast cancer survivors. We sought to identify risk factors that predicted the timing and development of lymphedema.

Methods: Women with breast cancer that underwent sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) at our institution between 2007 and 2022 were identified and sociodemographic and clinical information was extracted. We used logistic regression analysis to identify risk factors for lymphedema and performed cox-regression analysis to predict the timing of lymphedema presentation after surgery.

Results: We identified 1,223 patients, of which 161 (13.2%) developed lymphedema within 1.8 (mean, SD = 2.5) years postoperatively. Patients with SLNB had significantly lower odds for lymphedema development (vs. ALND, OR = 0.29 [0.14-0.57]). Patients between 40 and 49 years of age, and 50-59 (vs. <40 years, OR = 2.14 [1.00-4.60]; OR = 2.42, [1.13-5.16] respectively), African American patients (vs. Caucasian, OR = 1.86 [1.12-3.09]), patients with stage II, III, and IV disease (vs. stage 0, OR = 3.75 [1.36-10.33]; OR = 6.62 [2.14-20.51]; OR = 9.36 [2.94-29.81]), and patients with Medicaid (vs. private insurance, OR = 3.56 [1.73-7.28]) had higher rates of lymphedema. Cox-regression analysis showed that African American (HR = 1.71 [1.08-2.70]), higher BMI (HR = 1.03 [1.00-1.06]), higher stage (stage II, HR = 2.22 [1.05-7.09]; stage III, HR = 5.26 [1.86-14.88]; stage IV, HR = 6.13 [2.12-17.75]), and Medicaid patients (HR = 2.15 [1.12-3.80]) had higher hazards for lymphedema. Patients with SLNB had lower hazards for lymphedema (HR = 0.43 [0.87-2.11]).

Conclusion: Lymphedema has identifiable risk factors that can reliably be used to predict the chances of lymphedema development and enable clinicians to educate patients better and formulate treatment plans accordingly.

Level of evidence: III (Retrospective study).

Keywords: breast cancer lymphedema; lymph node excision; mastectomy; risk factors.