哈佛医学院麻省总医院：乳腺癌患者患侧抽血、注射、测血压及航空飞行发生淋巴水肿的风险

　　2016年3月1日出版的美国临床肿瘤学会（ASCO）官方期刊《临床肿瘤学杂志》（JCO）正式发表了哈佛医学院麻省总医院的一项研究全文，对乳腺癌治疗患者进行患侧抽血、注射、测血压、创伤、蜂窝织炎及航空飞行与（患侧）上肢周径增加的关系以及淋巴水肿的调查。该研究摘要曾发表于2014年圣安东尼奥乳腺癌研讨会（SABCS）。

　　2005～2014年，作者对在哈佛医学院麻省总医院进行治疗的乳腺癌患者进行淋巴水肿筛查。在术前和术后用周长仪测量双上肢周径。在每次测量中患者记录抽血、注射和测血压的次数、高危上肢伤及乘机次数直到最后一次测试。用相对周径改变和权重调整的变化公式对上肢周径进行量化。用线性随机效应模型评估除了临床特征外还有相对上肢周径（作为一个连续变量）和非治疗危险因素之间的关系。

　　结果共测量了3041例患者，在相对上肢周径（上肢水肿）或因体重增加调整后周径的改变与下列因素无明显相关：一次或多次抽血（P=0.62）、注射（P=0.77）、飞行次数（与0次相比：1或2次，P=0.77；≥3次，P=0.91）、飞行持续时间（与无飞行相比：1～2小时，P=0.43；≥12h，P=0.54）。通过多变量分析提示下列因素与上肢周径增加明显相关：体重指数≥25（P=0.0236）、腋窝淋巴结清除（P＜0.001）、局部淋巴结照射（P=0.0364）及蜂窝织炎（P＜0.001）。

　　该研究认为，尽管蜂窝织炎会增加淋巴水肿的发生风险，但患侧抽血、注射、测血压及空中飞行可能与上肢周径增加（上肢水肿）无关。这个研究结果可能有助于医生和患者了解（乳腺癌）治疗后发生淋巴水肿的风险、预防及管理。

J Clin Oncol. 2016 Mar 1;34(7):691-8.

Impact of Ipsilateral Blood Draws, Injections, Blood Pressure Measurements, and Air Travel on the Risk of Lymphedema for Patients Treated for Breast Cancer.

Ferguson CM, Swaroop MN, Horick N, Skolny MN, Miller CL, Jammallo LS, Brunelle C, O'Toole JA, Salama L, Specht MC, Taghian AG.

Massachusetts General Hospital, Harvard Medical School, Boston, MA.

PURPOSE: The goal of this study was to investigate the association between blood draws, injections, blood pressure readings, trauma, cellulitis in the at-risk arm, and air travel and increases in arm volume in a cohort of patients treated for breast cancer and screened for lymphedema.

PATIENTS AND METHODS: Between 2005 and 2014, patients undergoing treatment of breast cancer at our institution were screened prospectively for lymphedema. Bilateral arm volume measurements were performed preoperatively and postoperatively using a Perometer. At each measurement, patients reported the number of blood draws, injections, blood pressure measurements, trauma to the at-risk arm(s), and number of flights taken since their last measurement. Arm volume was quantified using the relative volume change and weight-adjusted change formulas. Linear random effects models were used to assess the association between relative arm volume (as a continuous variable) and nontreatment risk factors, as well as clinical characteristics.

RESULTS: In 3,041 measurements, there was no significant association between relative volume change or weight-adjusted change increase and undergoing one or more blood draws (P = .62), injections (P = .77), number of flights (one or two [P = .77] and three or more [P = .91] v none), or duration of flights (1 to 12 hours [P = .43] and 12 hours or more [P = .54] v none). By multivariate analysis, factors significantly associated with increases in arm volume included body mass index ≥ 25 (P = .0236), axillary lymph node dissection (P < .001), regional lymph node irradiation (P = .0364), and cellulitis (P < .001).

CONCLUSION: This study suggests that although cellulitis increases risk of lymphedema, ipsilateral blood draws, injections, blood pressure readings, and air travel may not be associated with arm volume increases. The results may help to educate clinicians and patients on posttreatment risk, prevention, and management of lymphedema.

PMID: 26644530

PII: JCO615948

DOI: 10.1200/JCO.2015.61.5948