乳腺癌相关淋巴水肿注意事项：来自航空旅行、患侧手臂血压测量、皮肤穿刺、极端温度和蜂窝组织炎的风险

　　2016年9月，英国《柳叶刀肿瘤学分册》正式发表美国哈佛大学医学院麻省总医院（马萨诸塞州综合医院）放疗科和理疗科的系统回顾，通过查阅文献确定了检查生活方式相关危险因素（空中旅行、患侧手臂血压测量、皮肤穿刺、极端温度和皮肤感染，如蜂窝组织炎）是否增加乳腺癌相关淋巴水肿风险的31篇原创研究论文。其中为数不多的研究为预防指南提供了支持，大多数提供了淋巴水肿与这些风险因素之间相关性的低级别（3～5级）或不确定的证据，仅4项2级研究表明存在显著相关性。皮肤感染及同侧手臂既往感染或炎症对淋巴水肿是最明确的风险因素之一。高水平证据的缺乏以及与现有文献的相互矛盾，令人很难为乳腺癌相关淋巴水肿明确预测因素，这可能是患者困扰和焦虑的重要原因。随着对这些风险因素的进一步研究，有关指南修改的不断讨论和风险校正方法调整是必要的。

Lancet Oncol. 2016 Sep;17(9):e392-e405.

Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis.

Maria S Asdourian, Melissa N Skolny, Cheryl Brunelle, Cara E Seward, Laura Salama, Alphonse G Taghian.

Department of Radiation Oncology, Department of Physical and Occupational Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Precautionary recommendations conveyed to survivors of cancer by health-care practitioners to reduce the risk of breast cancer-related lymphoedema are indispensable aspects of clinical care, yet remain unsubstantiated by high-level scientific evidence. By reviewing the literature, we identified 31 original research articles that examined whether lifestyle-associated risk factors (air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and skin infections—eg, cellulitis) increase the risk of breast cancer-related lymphoedema. Among the few studies that lend support to precautionary guidelines, most provide low-level (levels 3-5) or inconclusive evidence of an association between lymphoedema and these risk factors, and only four level 2 studies show a significant association. Skin infections and previous infection or inflammation on the ipsilateral arm were among the most clearly defined and well established risk factors for lymphoedema. The paucity of high-level evidence and the conflicting nature of the existing literature make it difficult to establish definitive predictive factors for breast cancer-related lymphoedema, which could be a considerable source of patient distress and anxiety. Along with further research into these risk factors, continued discussion regarding modification of the guidelines and adoption of a risk-adjusted approach is needed.

DOI: 10.1016/S1470-2045(16)30204-2