基于上肢淋巴引流的乳腺癌术后水肿风险因素分析  

Risk factors analysis of breast cancer-related lymphedema based on the proportion of the arm lymph flow above and below the axillary vein

作　　者：袁芊芊 侯晋轩[1] 苏科华[2] 冯秦玉 兰柳逸 郑乐葳 邹声泉[3] 吴高松 Yuan Qianqian;Hou Jinxuan;Su Kehua;Feng Qinyu;Lan Liuyi;Zheng Lewei;Zou Shengquan;Wu Gaosong(Department of Thyroid and Breast Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;School of Computer Science,Wuhan University,Wuhan 430072,China;Department of General Surgery,Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]武汉大学中南医院甲状腺乳腺外科,430071 [2]武汉大学计算机学院,430072 [3]华中科技大学同济医学院附属同济医院普通外科,武汉430030

出　　处：《中华普通外科杂志》2021年第8期579-584,共6页Chinese Journal of General Surgery

基　　金：武汉大学中南医院转化医学及交叉学科研究联合基金项目(ZNJC201935)。

摘　　要：目的探讨术中评估乳腺癌患者发生上肢淋巴水肿的风险因素。方法前瞻性纳入2019年5—12月武汉大学中南医院甲状腺乳腺外科拟行腋窝淋巴结清扫(axillary lymph node dissection,ALND)的312例上肢淋巴荧光图像及随访资料完整的乳腺癌患者,利用荧光造影剂吲哚菁绿联合红外荧光探测仪示踪上肢淋巴回流,收集上肢淋巴造影图,计算腋静脉上下上肢淋巴流量比。随访上臂固定点周径、计算双侧上臂体积,患侧比健侧增大10%定义为上肢淋巴水肿。利用单因素和多因素二元逻辑回归分析影响水肿的风险因素。结果本组患者的中位随访时间为15(12~19)个月,45例(14.4%)患者发生上肢淋巴水肿。多因素分析结果显示:BMI[OR 95%CI:1.34(1.25~1.77),P<0.05]、化疗[OR 95%CI:2.26(1.97~2.63),P<0.05]、区域淋巴结放疗[OR 95%CI:1.59(1.05~2.41),P<0.05]及腋静脉上下上肢淋巴流量比[OR 95%CI:0.70(0.68~0.81),P<0.05]为乳腺癌术后上肢淋巴水肿发生的独立风险因子,得到水肿风险预测方程式LogitY=0.369×(手术时患者的BMI)+0.713×(紫杉类化疗)+0.862×(区域淋巴结放疗)-9.058×(腋静脉上下上肢淋巴流量比)-6.860。绘制ROC曲线得出约登指数为0.119,敏感性、特异性、阳性预测值、阴性预测值分别为93.3%、79.4%、73.3%、98.6%。结论对拟行ALND手术的乳腺癌患者,基于腋静脉上下上肢淋巴流量比的临床预测模型是一种评估术后上肢淋巴水肿发生风险的方法,有助于临床医生对可能发生水肿的患者进行早期干预。Objective To develop and validate an clinical prediction model for the risk of breast cancer-related lymphedema(BCRL).Methods Breast cancer patients who were prepared to undergo axillary lymph node dissection were propsectively enrolled,indocyanine green combined with Photodynamic Eye(PDE)was applied to reveal the arm lymphatic flow.The arm lymphatic fluorescence images were collected to calculate the proportion of arm lymph flow above and below the axilla vein.Volumetric measurements of both arms and subjective questionnaire were performed to evaluate the occurrence of lymphedema.A difference in volume between the arms>10%was defined as lymphedema.Univariate logistic regression analysis was used to analyze the relationship between each factor and BCRL.The stepwise forward method was used to include multiple factors in the logistic regression analysis to establish the prediction model.Results Three hundred and twelve patients were enrolled.Fourty-five(14.4%)patients developed BCRL.Using the coefficients obtained from multivariate analysis,BMI(OR 95%CI:1.34(1.25-1.77),P<0.05),chemotherapy(OR 95%CI:2.26(1.97-2.63),P<0.05),regional lymph node radiotherapy(OR 95%CI:1.59(1.05-2.41),P<0.05)and the proportion of arm lymph flow above the level of the axillary vein(OR 95%CI:0.70(0.68-0.81),P<0.05)were identified as independent predictive factors for BCRL,and the following prediction equation was derived:Y=0.369×(BMI at surgery)+0.713×(taxane-based chemotherapy)+0.862×(radiotherapy)-9.058×(proportion of the arm lymph above the axillary vein)-6.8598.The ROC curve was screened to the optimal boundary value of 0.1186 by the Youden's index.The sensitivity,specificity,positive predictive value and negative predictive value of prediction of this model were 93.3%,79.4%,73.3%,98.6%,respectively.Conclusion With the guidance of the predictive model,particular patients who need the preservation of axillary lymphatic system can be identified,and timely intervention can be carried out.

关 键 词：乳腺肿瘤 水肿 危险因素 

分 类 号：R737.9[医药卫生—肿瘤]