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Background <p>Breast cancer is the most common malignancy among women globally, with 2.3 million new cases in 2022. Advances in early detection and treatment have improved survival, but long-term complications like breast cancer-related lymphoedema (BCRL) remain underrecognized. Affecting 6–40% of patients following axillary lymph node dissection, BCRL leads to chronic swelling, pain, and reduced quality of life. The risk is heightened in low- and middle-income countries (LMICs), where delayed diagnosis and limited awareness necessitate more aggressive interventions. Despite its profound physical, psychosocial, and economic impact, BCRL remains understudied in LMICs, highlighting the need for region-specific data and preventive strategies.</p> Methods <p>This prospective observational study, which was conducted in a tertiary care centre over 18&#xa0;months (July 2022–December 2023), aimed to identify clinicopathological predictors of the development of early ipsilateral arm lymphoedema in patients undergoing Modified radical mastectomy (MRM). We diagnosed lymphoedema via circumferential measurements (≥ 10% increase in ipsilateral arm) at 1&#xa0;day pre-surgery and followed up the patients at 1-, 3-, and 6-months post-surgery. Variables included patient demographics, tumour characteristics, and treatment factors.</p> Results <p>We recruited 80 patients, and 21 of them (26.25%) developed lymphoedema in 6&#xa0;month period, with significant predictors identified as BMI (mean 28.42 vs. 26.04&#xa0;kg/m<sup>2</sup>,&#xa0;<i>p</i> = <i>0.008</i>), Left-sided tumours (40% vs. 18% for right-sided,&#xa0;<i>p</i> = <i>0.03</i>), number of lymph nodes removed (mean 21.14 vs. 13.49,&#xa0;<i>p</i> = <i>0.003</i>), and positive lymph nodes (mean 3.81 vs. 1.15,&#xa0;<i>p</i> = <i>0.009</i>), Axillary radiation (55% vs. 16.7%,&#xa0;<i>p</i> &lt; <i>0.001</i>). Multivariate analysis confirmed BMI (aOR = 1.19, 95%CI:1.00–1.42;&#xa0;p = 0.045), total lymph nodes removed (aOR = 1.08, 95%CI:1.01–1.15;&#xa0;<i>p</i> = 0.027), and axillary radiation (aOR = 4.57, 95%CI:1.37–15.26;&#xa0;p = 0.013) as independent predictors, while positive lymph nodes lost significance when adjusted for confounders (aOR = 1.04,&#xa0;<i>p</i> = 0.718). Age, hormone receptor status, and chemotherapy type showed no significant associations.</p> Conclusion <p>The study highlights the critical role of pre-operative risk stratification. These findings underscore the need for personalized surgical and adjuvant strategies to mitigate Lymphoedema risk, enhancing long-term survivorship care in breast cancer patients.</p> Trial registration <p>Clinical Trials Registry India—CTRI/2023/08/056411 (Registered prospectively on 11/08/2023).</p>

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Predictors of early arm lymphoedema in breast cancer patients treated with modified radical mastectomy -a prospective observational study

  • 期刊论文

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  • 发表日期：

    2025年11月5日

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  • Mohd Ozair Khan,
  • Farhanul Huda,
  • Shalinee Rao,
  • Vidhu Shekhar Khare,
  • Kanmathareddy Amulya,
  • Nirmal Raj,
  • Adarsh Jha,
  • Aditya Arnav,
  • Somprakas Basu

摘要

Background

Breast cancer is the most common malignancy among women globally, with 2.3 million new cases in 2022. Advances in early detection and treatment have improved survival, but long-term complications like breast cancer-related lymphoedema (BCRL) remain underrecognized. Affecting 6–40% of patients following axillary lymph node dissection, BCRL leads to chronic swelling, pain, and reduced quality of life. The risk is heightened in low- and middle-income countries (LMICs), where delayed diagnosis and limited awareness necessitate more aggressive interventions. Despite its profound physical, psychosocial, and economic impact, BCRL remains understudied in LMICs, highlighting the need for region-specific data and preventive strategies.

Methods

This prospective observational study, which was conducted in a tertiary care centre over 18 months (July 2022–December 2023), aimed to identify clinicopathological predictors of the development of early ipsilateral arm lymphoedema in patients undergoing Modified radical mastectomy (MRM). We diagnosed lymphoedema via circumferential measurements (≥ 10% increase in ipsilateral arm) at 1 day pre-surgery and followed up the patients at 1-, 3-, and 6-months post-surgery. Variables included patient demographics, tumour characteristics, and treatment factors.

Results

We recruited 80 patients, and 21 of them (26.25%) developed lymphoedema in 6 month period, with significant predictors identified as BMI (mean 28.42 vs. 26.04 kg/m2, p = 0.008), Left-sided tumours (40% vs. 18% for right-sided, p = 0.03), number of lymph nodes removed (mean 21.14 vs. 13.49, p = 0.003), and positive lymph nodes (mean 3.81 vs. 1.15, p = 0.009), Axillary radiation (55% vs. 16.7%, p < 0.001). Multivariate analysis confirmed BMI (aOR = 1.19, 95%CI:1.00–1.42; p = 0.045), total lymph nodes removed (aOR = 1.08, 95%CI:1.01–1.15; p = 0.027), and axillary radiation (aOR = 4.57, 95%CI:1.37–15.26; p = 0.013) as independent predictors, while positive lymph nodes lost significance when adjusted for confounders (aOR = 1.04, p = 0.718). Age, hormone receptor status, and chemotherapy type showed no significant associations.

Conclusion

The study highlights the critical role of pre-operative risk stratification. These findings underscore the need for personalized surgical and adjuvant strategies to mitigate Lymphoedema risk, enhancing long-term survivorship care in breast cancer patients.

Trial registration

Clinical Trials Registry India—CTRI/2023/08/056411 (Registered prospectively on 11/08/2023).