背景:淋巴水肿是全球被忽视的医疗保健问题,也是乳腺癌治疗后的常见并发症。淋巴水肿是众所周知的蜂窝织炎的诱发因素,但很少有人在国际范围内调查该患者队列中蜂窝织炎的危险因素.这项研究的目的是确定手臂淋巴水肿患者蜂窝织炎的频率,包括蜂窝织炎的潜在危险因素。
方法:国际,多中心,横断面研究,包括临床评估的手臂淋巴水肿患者。主要结果是在过去12个月内,手臂蜂窝织炎伴淋巴水肿的发生率。及其潜在的相关风险因素。次要结果是蜂窝织炎的终生患病率。包括具有临床评估的手臂淋巴水肿/慢性水肿(所有原因)并能够给予知情同意的成年人。生命结束患者或被认为不符合患者最佳利益的患者被排除在外。进行了单变量和多变量分析。
结果:总共2160名来自澳大利亚的患者,丹麦,法国,爱尔兰,意大利,Japan,土耳其和英国。98%的患者存在继发性淋巴水肿;其中95%被认为与癌症或其治疗有关。蜂窝织炎的终生患病率为22%,1年发病率为11%。经过多变量分析,与近期蜂窝织炎相关的因素是肿胀持续时间较长和淋巴水肿控制不佳.与小于1年的淋巴水肿相比,风险随持续时间增加:1-2年(OR2.15),2-5年(OR2.86),5-10年(OR3.15)。淋巴水肿控制良好的患者患蜂窝织炎的风险降低46%(OR0.54,95%CI0.39-0.73,p<0.001)。即使在调整肿胀持续时间和通过逻辑回归控制肿胀后,淋巴水肿的晚期也与蜂窝织炎相关(II期OR5.44,III期OR9.13,p=0.002),在亚组分析中证明。
结论:晚期手臂淋巴水肿患者特别容易发生蜂窝织炎。预防淋巴水肿进展至关重要。结果有助于治疗良好的淋巴水肿对蜂窝织炎的频率产生积极影响。
BACKGROUND: Lymphoedema is a globally neglected health care problem and a common complication following breast cancer treatment. Lymphoedema is a well-known predisposing factor for cellulitis, but few have investigated the risk factors for cellulitis in this patient cohort on an international level. The aim of this
study was to identify the frequency of cellulitis in patients with lymphoedema of the arm, including potential risk factors for cellulitis.
METHODS: An international, multi-centre, cross-sectional
study including patients with clinically assessed arm lymphoedema. The primary outcome was the incidence of cellulitis located to the arm with lymphoedema within the last 12 months, and its potential associated risk factors. The secondary outcome was life-time prevalence of cellulitis. Adults with clinically-assessed arm lymphoedema/chronic oedema (all causes) and able to give informed consent were included. End-of-life-patients or those judged as not in the patient\'s best interest were excluded. Both univariable and multivariable analysis were performed.
RESULTS: A total of 2160 patients were included from Australia, Denmark, France, Ireland, Italy, Japan, Turkey and United Kingdom. Secondary lymphoedema was present in 98% of the patients; 95% of these were judged as related to cancer or its treatment. The lifetime prevalence of cellulitis was 22% and 1-year incidence 11%. Following multivariable analysis, factors associated with recent cellulitis were longer swelling duration and having poorly controlled lymphoedema. Compared to having lymphoedema less than 1 year, the risk increased with duration: 1-2 years (OR 2.15), 2-5 years (OR 2.86), 5-10 years (OR 3.15). Patients with well-controlled lymphoedema had a 46% lower risk of cellulitis (OR 0.54, 95% CI 0.39-0.73, p < 0.001). More advanced stages of lymphoedema were associated with cellulitis even after adjustment for swelling duration and control of swelling by logistic regression (stage II OR 5.44, stage III OR 9.13, p = 0.002), demonstrated in a subgroup analysis.
CONCLUSIONS: Patients with advanced arm lymphoedema are at particular risk of developing cellulitis. Prevention of lymphoedema progression is crucial. The results lend towards a positive effect of having well-treated lymphoedema on the frequency of cellulitis.