体重变化与乳腺癌淋巴水肿风险
淋巴水肿是乳腺癌治疗的重要并发症之一，根据美国麻省总医院和哈佛大学医学院的调查，5年总发生率为13.7%，其中前哨淋巴结活检＋区域淋巴结放疗后、腋窝淋巴结清扫后、腋窝淋巴结清扫＋区域淋巴结放疗后的5年总发生率分别为12.2%、24.6%、31.2%。虽然术前体重指数高是乳腺癌相关淋巴水肿的公认风险因素，但是术后体重减轻或增加的影响尚不明确。少数研究对术后体重变化与乳腺癌相关淋巴水肿的相关性进行过分析，可是样本量较小，或根据患者主观报告淋巴水肿、体重、体重指数等指标，或淋巴水肿为事后回顾评定，或缺乏术前手臂体积测量值，或未能分别评定体重减轻和体重增加的影响。
2021年7月27日，美国癌症学会《癌症》在线发表美国麻省总医院和哈佛大学医学院的研究报告，对术后体重变化与乳腺癌相关淋巴水肿的关联进行了大样本前瞻定量分析。
该队列研究对2005～2020年进行单侧乳腺癌手术的1161例女性乳腺癌相关淋巴水肿进行前瞻筛查，术前、术后和每6～12个月随访时通过光电血测量仪对手臂体积进行测定。主要结局为乳腺癌相关淋巴水肿，定义为术后至少3个月与术前相比同侧手臂体积增加≥10%。
结果，从术前到术后末次随访平均49.1个月，共计92例患者（7.9%）发生乳腺癌相关淋巴水肿。
从术前到术后末次随访，512例体重净减患者与649例体重净增患者相比，乳腺癌相关淋巴水肿风险并未减少（风险比：1.38，95%置信区间，0.89～2.13，P=0.152）。
因此，该单中心大样本队列前瞻观察研究结果表明，虽然体重减轻可能被推荐作为个体化生活方式管理计划的一部分以促进整体健康，但是单靠减轻体重可能并不减少乳腺癌相关淋巴水肿风险。
不过，该研究并未定期对患者测定体重，而且随访最短仅1.2个月。此外，该研究并未收集每位患者整个乳腺癌治疗期间的生活习惯信息，无法明确体重减轻是由于运动或控制饮食等健康习惯主动减肥，还是由于化疗或其他乳腺癌相关因素被动减重。最重要的是，由于体重稳定患者仅67例，无法分析体重稳定对乳腺癌相关淋巴水肿风险的影响，故有必要进一步开展多中心大样本随机对照前瞻干预研究进行验证。
Cancer. 2021 Jul 27. Online ahead of print.
Weight loss does not decrease risk of breast cancer-related arm lymphedema.
Roberts SA, Gillespie TC, Shui AM, Brunelle CL, Daniell KM, Locascio JJ, Naoum GE, Taghian AG.
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Weight loss, when compared to weight gain, does not decrease the risk of breast cancer-related lymphedema (hazard ratio, 1.38; 95% confidence interval, 0.89-2.13; P = 0.152).
BACKGROUND: The goal of this study was to determine the relationship between postoperative weight change and breast cancer-related lymphedema (BCRL).
METHODS: In this cohort study, 1161 women underwent unilateral breast surgery for breast cancer from 2005 to 2020 and were prospectively screened for BCRL. Arm volume measurements were obtained via an optoelectronic perometer preoperatively, postoperatively, and in the follow-up setting every 6 to 12 months. Mean follow-up from preoperative baseline was 49.1 months. The main outcome was BCRL, defined as a relative volume change of the ipsilateral arm of ≥10% at least 3 months after surgery.
RESULTS: A total of 92 patients (7.9%) developed BCRL. Net weight loss versus net weight gain from baseline to last follow-up was not protective against developing BCRL (hazard ratio, 1.38; 95% confidence interval, 0.89-2.13; P = 0.152).
CONCLUSIONS: Although weight loss may be recommended as part of an individualized lifestyle management program for overall health, weight loss alone may not decrease the risk of developing BCRL.
KEYWORDS: breast cancer; breast cancer-related lymphedema; lymphedema; weight change
PMID: 34314022
DOI: 10.1002/cncr.33819