Risk of Lymphedema and Death after Lymph Node Dissection with Neoadjuvant and Adjuvant Treatments in Patients with Breast Cancer: An Eight-Year Nationwide Cohort Study.
Ye-Seul LeeYu-Cheol LimJiyoon YeoSong-Yi KimYoon-Jae LeeIn Hyuk HaPublished in: Healthcare (Basel, Switzerland) (2023)
Knowledge on the impact of neoadjuvant and adjuvant treatments on post-surgery lymphedema (LE) in patients with breast cancer is limited due to methodological limitations and an insufficient sample size. We investigated the risk of LE in patients going through long-term anticancer treatment regimens using a national cohort from the Korean National Health Insurance Service database from 2011-2013. Incidence rate ratio, Kaplan-Meier analysis, and Cox proportional regression analysis were performed. A total of 39,791 patients were included. While minimal lymph node dissection (SLNB) reduced the risk of LE (hazard ratio [HR] 0.51) as expected, neoadjuvant chemotherapy (NAC) followed by SLNB did not reduce the risk. Adjusting for adjuvant chemotherapy (AC) as time-varying exposure decreased the risk of LE in the SLNB group (HR 0.51), but not the mortality risk (HR 0.861). A longer duration of NAC, especially taxane-based, combined with SLNB reversed the effect and increased risk of LE. The findings highlight the importance of not only early surveillance before and after surgery, but also long-term surveillance during adjuvant treatment by surgeons and oncologists in order to reduce the risk of LE.
Keyphrases
- neoadjuvant chemotherapy
- lymph node
- rectal cancer
- end stage renal disease
- health insurance
- locally advanced
- early stage
- chronic kidney disease
- ejection fraction
- newly diagnosed
- sentinel lymph node
- healthcare
- public health
- quality improvement
- prognostic factors
- transcription factor
- radiation therapy
- risk factors
- emergency department
- minimally invasive
- cross sectional
- coronary artery disease
- mass spectrometry
- palliative care
- combination therapy
- acute coronary syndrome
- replacement therapy
- atrial fibrillation
- adverse drug
- drug induced