Asian Pac J Cancer Prev, 15 (16), 6535-6541
IntroductionBreast cancer related lymphedema (BCRL)is a chronic and common complication caused by abnormal accumulation of protein-rich fluid in the interstitial space secondary to inadequate lymphatic drainage, which manifests unilateral or bilateral upper extremity swelling in the clinical. (Cheville et al., 2003). Lymphedema and its related symptoms (pain, heaviness, tightness, and decreased range of motion) seriously affect recreational and social relationships (Hayes et al., 2012). Patients with BCRL have a lower quality of life, a higher level of anxiety or depression (Pyszel et al., 2006;Heiney et al., 2007).Due to differences in study designs, measurement methods and criterias , length of follow-up, lymphedema definitions and timing of lymphedema measurement since diagnosis and treatment, previous studies have shown about 20% of breast cancer survivors will develop lymphedema. (sakorafas et al., 2006) In recent years, many studies have established risk factors of BCRL, but conclusions are not consistent, which even contradict each other from some studies. The study systematically reviews the risk factors for BCRL with meta-analysis method to increase the credibility of the conclusions for the purpose of providing scientific evidence for early prevention of lymphedema in clinical work.
Materials and Methods
Literature SearchWe searched comprehensively clinical studies which were published in PubMed, Ovid, EMbase, the Cochrane Library from January 1, 1996 to December 30, 2012. The MeSH headings and keywords in this search used included "breast cancer", "upper extremity", "lymphedema" and "risk factors" Relevant articles were identified and their references were checked for additional studies.The search strategy used: ( ("Breast Neoplasms" (Mesh) AND "Upper Extremity" (Mesh)) AND ("Lymphedema" (Mesh) OR "Edema" (Mesh)) AND ("1996/01/01" (PDAT) : "2012/12/31" (PDAT))
Inclusion and Exclusion CriteriaInclusion criteria: studies of female patients with unilateral breast cancer; the primary studies of risk factors for BCRL published abroad.Exclusion criteria: studies of patients with bilateral breast cancer, primary lymphoedema, or metastatic disease (n=258); review, meta-analyses, editorial, comment , and case reports (n=121); studies that did not either inform OR and 95%CI or provide adequate information to calculate the OR and its variance (n=39); non-English-language studies (n=8).