Risk factors for development of upper limb lymphedema in patients submitted to surgery for breast cancer

ABSTRACT

OBJECTIVE: Lymphedema (LE) is an important sequel of lymph node dissection for breast cancer. However, the etiology of LE has never been fully clarified, despite its negative impact on quality of life. The aim of this study was to identify risk factors for upper limb LE in patients submitted to surgery for breast cancer. METHODS: This was a case-control study of 325 women with breast cancer submitted to axillary lymphadenectomy at the Ceará Cancer Institute between January 2000 and December 2007. The study population consisted of 101 LE patients and 224 controls. LE was defined as a > 10% difference in volume between the upper limbs on plethysmography. The dependent variables included, age, body mass index, type of surgery, postoperative complications and type of adjuvant treatment. RESULTS: The study identified three risk factors for LE: tumor stage II or higher (OR: 4.33; CI: 95%), surgical wound infection (OR: 1.0; CI: 95%) and irradiation of the supraclavicular fossa (OR: 2.90; CI: 95%). The prevalence of LE increased with the number of risk factors presented by each patient. The probability of developing LE was 6.95% for subjects with none of the risk factors identified in the study, 26.1% for one factor, 56% for two factors and 100% for all three factors. CONCLUSION: The main risk factors for LE identified in the present study were tumor stage II or higher, surgical wound infection and irradiation of the supraclavicular fossa. Based on these findings, an LE predictive score was devised for the study population.