不同初始肿胀部位乳腺癌相关淋巴水肿的特异性危险因素

doi:10.3969/j.issn.1006-9771.2025.10.015

Abstract

Abstract:

Objective To explore the clinical characteristics and specific risk factors of breast cancer-related lymphedema (BCRL) patients with different initial swelling sites (chest wall, upper arm, forearm and hand).
Methods A total of 130 BCRL inpatients in Jing'an District Centre Hospital of Shanghai from December, 2015 to March, 2024 were reviewed. The patients were grouped by initial swelling sites; baseline characteristics, treatment methods, edema indicators and upper limb dysfunction were compared among groups.
Results The sample size of the chest wall group was too small (n = 2), so it was excluded from the statistical analysis. There was no significant difference in baseline characteristics, treatment methods, edema indicators or the upper limb dysfunction among the other three groups. Multivariate Logistic regression analysis showed that: age (OR = 1.059, P = 0.013) and edema onset time (OR = 0.984, P = 0.011) were the independent related factors for initial swelling in the upper arm, edema onset time (OR = 1.014, P = 0.011) was the independent risk factor for initial swelling in the forearm, and limitation of shoulder motion (OR = 0.125, P = 0.044) was the independent protective factor for initial swelling in the hand.
Conclusion Age, edema onset time and shoulder joint function of BCRL patients may affect the initial sites of swelling. The initial sites of swelling may indicate different etiologies of edema.

Key words: breast cancer, lymphedema, swelling sites, risk factors

CLC Number:

R737.9

XIE Na, LI Li, JIA Jie. Specific risk factors among initial swelling sites of breast cancer-related lymphedema[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1234-1240.

Figures/Tables 4

Table 1

Table 2

Table 3

Table 4

References 20

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变量		胸壁组(n = 2)^a	上臂组(n = 57)	前臂组(n = 50)	手部组(n = 21)	H/χ²值	P值
年龄/岁		48.50±9.19	59.98±8.77	55.74±11.46	55.62±12.40	5.969	0.130
BMI/(kg·m^-2)		20.50±0.99	24.54±3.31	24.43±3.91	24.09±3.20	4.044	0.645
利手侧/n	左	0	1	2	1	0.741	0.717
	右	2	56	48	20
手术侧/n	左	0	33	25	12	4.368	0.839
	右	2	20	20	8
	双侧	0	4	5	1
前哨活检/n	是	0	5	5	2	0.255	0.976
	否	2	52	45	19
淋巴结摘除数		14.50±10.61	11.35±8.48	11.90±8.49	14.00±11.19	2.356	0.349
放疗/n	是	2	39	34	13	1.292	0.852
	否	0	18	16	8
化疗/n	是	2	47	44	16	2.012	0.449
	否	0	10	6	5
水肿侧/n	左	0	34	28	12	2.833	0.928
	右	2	23	22	9
水肿发生时间/月		0.25±0.35	17.63±40.28	32.78±55.38	25.62±34.80	7.592	0.147
水肿分级/n	0	0	1	1	1	10.499	0.161
	1	1	12	9	8
	2	1	24	26	11
	3	0	20	14	1
肩痛/n	是	1	18	15	7	0.402	0.960
	否	1	39	35	14
肩周炎/n	是	0	0	0	0	0.000	1.000
	否	2	57	50	21
肩袖损伤/n	是	1	8	7	3	2.039	0.999
	否	1	49	43	18
肩峰撞击/n	是	1	5	3	1	5.591	0.775
	否	1	52	47	20
肩关节活动受限/n	是	1	23	16	4	3.440	0.200
	否	1	34	34	17
关节活动度/°	前屈	160.00±28.28	152.18±43.92	159.84±41.26	168.81±30.16	3.185	0.218
	外展	145.00±49.50	145.88±50.24	155.74±47.81	168.57±31.83	4.356	0.123
	外旋	60.00±42.43	68.04±30.60	72.88±28.22	81.86±18.42	4.069	0.156
腋网综合征/n	是	1	1	2	0	15.910	0.552
	否	1	56	48	21
患肢瘫痪/n	是	0	5	2	2	1.335	0.558
	否	2	52	48	19
患肢异常感觉/n	是	1	8	6	3	2.339	0.943
	否	1	49	44	18

自变量	B	SE	Wald	OR(95%CI)	P值
年龄	0.057	0.023	6.181	1.059(1.012~1.108)	0.013
BMI	-0.032	0.061	0.277	0.968(0.859~1.092)	0.599
手术侧	-0.218	0.315	0.478	0.804(0.434~1.491)	0.489
利手侧	0.892	1.319	0.457	2.441(0.184~32.409)	0.499
放疗	0.484	0.479	1.018	1.622(0.634~4.148)	0.313
化疗	-0.117	0.601	0.038	0.889(0.274~2.887)	0.845
前哨活检	-0.060	0.801	0.006	0.942(0.196~4.524)	0.941
淋巴结摘除数量	-0.032	0.026	1.543	0.969(0.921~1.019)	0.214
水肿发生时间	-0.016	0.006	6.524	0.984(0.972~0.996)	0.011
水肿分级	0.191	0.307	0.386	1.210(0.663~2.209)	0.534
肩痛	-0.361	0.620	0.338	0.697(0.207~2.351)	0.561
肩袖损伤	-0.531	0.728	0.531	0.588(0.141~2.452)	0.466
肩峰撞击	0.278	0.823	0.114	1.321(0.263~6.628)	0.735
肩关节活动受限	0.753	0.596	1.599	2.124(0.661~6.828)	0.206
腋网综合征	-1.040	1.479	0.495	0.354(0.019~6.411)	0.482
患肢瘫痪	1.788	1.187	2.269	5.976(0.584~61.183)	0.132
患肢异常感觉	-0.894	0.765	1.364	0.409(0.091~1.833)	0.243

自变量	B	SE	Wald	OR(95%CI)	P值
年龄	-0.041	0.022	3.624	0.960(0.920~1.001)	0.057
BMI	0.030	0.062	0.240	1.031(0.913~1.164)	0.624
手术侧	0.221	0.311	0.505	1.247(0.678~2.295)	0.477
利手侧	-0.500	1.107	0.204	0.607(0.069~5.311)	0.652
放疗	-0.400	0.481	0.690	0.671(0.261~1.722)	0.406
化疗	0.642	0.639	1.010	1.901(0.543~6.647)	0.315
前哨活检	0.192	0.788	0.059	1.211(0.258~5.678)	0.808
淋巴结摘除数量	0.011	0.025	0.193	1.011(0.962~1.063)	0.660
水肿发生时间	0.014	0.006	6.461	1.014(1.003~1.025)	0.011
水肿分级	0.283	0.313	0.822	1.328(0.719~2.450)	0.365
肩痛	0.287	0.608	0.223	1.333(0.405~4.389)	0.637
肩袖损伤	0.077	0.725	0.011	1.080(0.261~4.471)	0.915
肩峰撞击	-0.602	0.837	0.518	0.547(0.106~2.826)	0.472
肩关节活动受限	0.134	0.572	0.055	1.144(0.373~3.511)	0.814
腋网综合征	0.343	1.263	0.074	1.409(0.119~16.753)	0.786
患肢瘫痪	-2.412	1.294	3.473	0.090(0.007~1.133)	0.062
患肢异常感觉	0.200	0.719	0.078	1.222(0.299~4.996)	0.781

自变量	B	SE	Wald	OR(95%CI)	P值
年龄	-0.029	0.030	0.963	0.971(0.916~1.030)	0.326
BMI	0.056	0.093	0.356	1.057(0.881~1.269)	0.551
手术侧	-0.147	0.437	0.114	0.863(0.367~2.031)	0.736
利手侧	-0.535	1.327	0.163	0.586(0.043~7.892)	0.687
放疗	-0.295	0.673	0.192	0.745(0.199~2.783)	0.661
化疗	-1.022	0.804	1.617	0.360(0.074~1.739)	0.203
前哨活检	0.151	1.114	0.018	1.163(0.131~10.328)	0.892
淋巴结摘除数量	0.046	0.036	1.641	1.047(0.976~1.123)	0.200
水肿发生时间	0.000	0.007	0.000	1.000(0.986~1.015)	0.989
水肿分级	-0.764	0.399	3.656	0.466(0.213~1.019)	0.056
肩痛	0.631	0.908	0.482	1.879(0.317~11.143)	0.488
肩袖损伤	0.436	1.067	0.167	1.547(0.191~12.533)	0.683
肩峰撞击	-0.352	1.342	0.069	0.703(0.051~9.574)	0.793
肩关节活动受限	-2.007	1.030	4.067	0.125(0.017~0.943)	0.044
腋网综合征	-18.614	19598.087	0.000	0.000	0.999
患肢瘫痪	1.853	1.559	1.413	6.377(0.301~135.286)	0.235
患肢异常感觉	0.095	1.106	0.007	1.100(0.126~9.610)	0.931

Specific risk factors among initial swelling sites of breast cancer-related lymphedema

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