Body Mass Index Increases the Risk of Breast Cancer-related Lymphedema at 6-18 months After Surgery: a Retrospective Study

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2023 Apr 19

PMID 37074508

Authors

Ling Wang

Hongbo Chen

Yuanzhen Li

Huixue Wang

Ning Liu

Miao Yu

Shaomei Shang

Affiliations

Soon will be listed here.

Abstract

Purpose: Breast cancer-related lymphedema (BCRL) is an incurable complication occurring after breast cancer treatment. The influence of obesity/overweight on the development of BCRL at different points after surgery was seldom verified. We aimed to determine the cut-off BMI/weight value associated with an increased risk of BCRL at different postoperative time in Chinese breast cancer survivors.

Methods: Patients who underwent breast surgery plus axillary lymph node dissection (ALND) were retrospectively evaluated. Disease and treatment characteristics of participants were collected. BCRL was diagnosed by circumference measurements. Univariate and multivariable logistic regression was used to assess the relationship of lymphedema risk with BMI/weight and other disease- and treatment-related factors.

Results: 518 patients were included. Lymphedema occurred more frequently among breast cancer patients with preoperative BMI ≥ 25 kg/m (37.88%) than among those with preoperative BMI < 25 kg/m(23.32%), with significant differences at 6-12 and 12-18 months after surgery (χ = 23.183, P = 0.000; χ = 5.279, P = 0.022). By multivariable logistics analysis, preoperative BMI ≥ 30 kg/m presented a significantly greater risk of lymphedema than a preoperative BMI < 25 kg/m (OR [95% CI] = 2.928 [1.565, 5.480]). Other factors, including radiation (breast/chest wall + axilla vs. none: OR [95% CI] = 3.723[2.271-6.104]), was an independent risk factor for lymphedema.

Conclusions: Preoperative obesity was an independent risk factor for BCRL in Chinese breast cancer survivors, and a preoperative BMI ≥ 25 kg/m indicated greater likelihood of lymphedema development within 6-18 months postoperatively.

Citing Articles

Protective Factors Associated with Normal Lymphatic Function After Axillary Lymph Node Dissection for Breast Cancer Treatment.

Coleman-Belin J, Rubin J, Boe L, Diwan R, Monge J, Dinh D Ann Surg Oncol. 2025; .

PMID: 39899216 DOI: 10.1245/s10434-025-16918-5.

External Validation of a 5-Factor Risk Model for Breast Cancer-Related Lymphedema.

Lin C, Su J, Wu A, Lin N, Hossack M, Shi W JAMA Netw Open. 2025; 8(1):e2455383.

PMID: 39836421 PMC: 11751742. DOI: 10.1001/jamanetworkopen.2024.55383.

Development and Validation of Upper Limb Lymphedema in Patients After Breast Cancer Surgery Using a Practicable Machine Learning Model: A Retrospective Cohort Study.

Peng X, Lu Z Int J Gen Med. 2024; 17:3799-3812.

PMID: 39246804 PMC: 11379040. DOI: 10.2147/IJGM.S478573.

Impact of obesity on sentinel lymph node biopsy outcomes and survival in breast cancer patients: A single-center retrospective study.

Pang J, Li L, Yin N, Dai M, Zheng S, Chen M Cancer Med. 2024; 13(9):e7248.

PMID: 38733197 PMC: 11087846. DOI: 10.1002/cam4.7248.

References

Dayan J, Ly C, Kataru R, Mehrara B . Lymphedema: Pathogenesis and Novel Therapies. Annu Rev Med. 2017; 69:263-276. DOI: 10.1146/annurev-med-060116-022900. View

DiSipio T, Rye S, Newman B, Hayes S . Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013; 14(6):500-15. DOI: 10.1016/S1470-2045(13)70076-7. View

Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M . Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology. 2009; 19(3):299-305. DOI: 10.1002/pon.1573. View

Hayes S, Janda M, Cornish B, Battistutta D, Newman B . Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008; 26(21):3536-42. DOI: 10.1200/JCO.2007.14.4899. View

Stolldorf D, Dietrich M, Ridner S . Symptom Frequency, Intensity, and Distress in Patients with Lower Limb Lymphedema. Lymphat Res Biol. 2016; 14(2):78-87. PMC: 4926205. DOI: 10.1089/lrb.2015.0027. View

Vassard D, Halgren Olsen M, Zinckernagel L, Vibe-Petersen J, Dalton S, Johansen C . Psychological consequences of lymphoedema associated with breast cancer: a prospective cohort study. Eur J Cancer. 2010; 46(18):3211-8. DOI: 10.1016/j.ejca.2010.07.041. View

Khan F, Amatya B, Pallant J, Rajapaksa I . Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer. Breast. 2012; 21(3):314-20. DOI: 10.1016/j.breast.2012.01.013. View

Zou L, Liu F, Shen P, Hu Y, Liu X, Xu Y . The incidence and risk factors of related lymphedema for breast cancer survivors post-operation: a 2-year follow-up prospective cohort study. Breast Cancer. 2018; 25(3):309-314. DOI: 10.1007/s12282-018-0830-3. View

Shaitelman S, Chiang Y, Griffin K, DeSnyder S, Smith B, Schaverien M . Radiation therapy targets and the risk of breast cancer-related lymphedema: a systematic review and network meta-analysis. Breast Cancer Res Treat. 2016; 162(2):201-215. DOI: 10.1007/s10549-016-4089-0. View

10.

Ridner S, Dietrich M, Stewart B, Armer J . Body mass index and breast cancer treatment-related lymphedema. Support Care Cancer. 2011; 19(6):853-7. PMC: 4480912. DOI: 10.1007/s00520-011-1089-9. View

11.

Helyer L, Varnic M, Le L, Leong W, McCready D . Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2009; 16(1):48-54. DOI: 10.1111/j.1524-4741.2009.00855.x. View

12.

Jammallo L, Miller C, Singer M, Horick N, Skolny M, Specht M . Impact of body mass index and weight fluctuation on lymphedema risk in patients treated for breast cancer. Breast Cancer Res Treat. 2013; 142(1):59-67. PMC: 3873728. DOI: 10.1007/s10549-013-2715-7. View

13.

Leray H, Malloizel-Delaunay J, Lusque A, Chantalat E, Bouglon L, Chollet C . Body Mass Index as a Major Risk Factor for Severe Breast Cancer-Related Lymphedema. Lymphat Res Biol. 2020; 18(6):510-516. DOI: 10.1089/lrb.2019.0009. View

14.

Flegal K, Kruszon-Moran D, Carroll M, Fryar C, Ogden C . Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016; 315(21):2284-91. PMC: 11197437. DOI: 10.1001/jama.2016.6458. View

15.

Ma S, Xi B, Yang L, Sun J, Zhao M, Bovet P . Trends in the prevalence of overweight, obesity, and abdominal obesity among Chinese adults between 1993 and 2015. Int J Obes (Lond). 2020; 45(2):427-437. DOI: 10.1038/s41366-020-00698-x. View

16.

Ancukiewicz M, Miller C, Skolny M, OToole J, Warren L, Jammallo L . Comparison of relative versus absolute arm size change as criteria for quantifying breast cancer-related lymphedema: the flaws in current studies and need for universal methodology. Breast Cancer Res Treat. 2012; 135(1):145-52. PMC: 3564235. DOI: 10.1007/s10549-012-2111-8. View

17.

Greene A, Grant F, Slavin S . Lower-extremity lymphedema and elevated body-mass index. N Engl J Med. 2012; 366(22):2136-7. DOI: 10.1056/NEJMc1201684. View

18.

Weitman E, Aschen S, Farias-Eisner G, Albano N, Cuzzone D, Ghanta S . Obesity impairs lymphatic fluid transport and dendritic cell migration to lymph nodes. PLoS One. 2013; 8(8):e70703. PMC: 3741281. DOI: 10.1371/journal.pone.0070703. View

19.

Savetsky I, Torrisi J, Cuzzone D, Ghanta S, Albano N, Gardenier J . Obesity increases inflammation and impairs lymphatic function in a mouse model of lymphedema. Am J Physiol Heart Circ Physiol. 2014; 307(2):H165-72. PMC: 4101643. DOI: 10.1152/ajpheart.00244.2014. View

20.

Aschen S, Zampell J, Elhadad S, Weitman E, De Brot Andrade M, Mehrara B . Regulation of adipogenesis by lymphatic fluid stasis: part II. Expression of adipose differentiation genes. Plast Reconstr Surg. 2012; 129(4):838-847. PMC: 3445411. DOI: 10.1097/PRS.0b013e3182450b47. View