Factors affecting lymphedema after neoadjuvant chemotherapy and axillary dissection in female breast cancer patients: A retrospective cohort study based on the Chinese population

Abstract

Purpose Breast cancer-related lymphedema (BCRL) is a common complication in breast cancer survivors. Most BCRL studies have focused on patients receiving adjuvant chemotherapy, and relatively little attention has been paid to BCRL in patients with neoadjuvant chemotherapy (NAC). This study aimed to investigate the risk factors associated with BCRL in Chinese women undergoing NAC and axillary lymph node dissection (ALND). Methods In our institution, this cohort study collected data from 336 women with clinically node-positive breast cancer who received NAC and ALND surgery from 2015 to 2020. The BCRL was assessed by objective measurement of limb circumference. Multivariate logistic regression was used to determine risk factors for BCRL, including clinical, demographic and lifestyle-related characteristics. Results The cumulative incidence of BCRL within 2.5 years was 43.75%. The factors independently associated with BCRL were radiotherapy (versus no radiotherapy; hazard ratio [HR]=1.611; P=0.020), NAC for 105 days or shorter (versus NAC for 105-143 days; HR=0.471; P=0.020), >15 lymph nodes removed (versus ≤15 lymph nodes removed; HR=1.593; P=0.036 ), drainage for 20-29 days (versus drainage for 10-19 days; HR=1.568; P=0.028), and sleeping biased toward affected arm (versus sleeping biased toward healthy arm; HR=2.033; P=0.019). Conclusion This study identified several risk factors for BCRL in breast cancer patients after NAC and ALND. Patients with one or more of these factors should be monitored carefully for early detection and intervention. Further research is needed to investigate the effects of drainage time and sleep position on the development of BCRL.