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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Tuesday, October 3, 2023
Accurately predicting the risk of breast cancer–related lymphedema—a common complication of axillary lymph node dissection that may also develop after sentinel lymph node biopsy—is the subject of new research published in JAMA Surgery. Acknowledging the lack of a widely used predictive framework for the condition, Babak J. Mehrara, MD, of Memorial Sloan Kettering Cancer Center (MSK), New York, and colleagues designed a study of nearly 2,000 patients to examine and address the perceived shortcomings of existing prediction models. The investigators claim they have developed and validated preoperative and postoperative models that are not only highly accurate, but also racially sensitive and comprising inputs that are easily accessible to patients and clinicians.
“To our knowledge, race has not yet been included in any breast cancer–related lymphedema predictive model, despite emerging evidence that Black women have an elevated [risk of the condition],” the study authors noted.
A total of 1,882 women with breast cancer who underwent axillary lymph node dissection or sentinel lymph node biopsy from 1999 to 2020 at MSK and the Mayo Clinic were included in the study. Using logistic regression, the investigators formulated a preoperative model and a postoperative model. The mean age of the participants was 55.6 years, of whom 4.3% were Asian, 10.1% were Black, 82.8% were White, and 2.9% were another race or of an unknown race. At the mean follow-up of 3.9 years, 11.6% of patients were diagnosed with breast cancer–related lymphedema. The rate was significantly higher among Black women (22.1%) compared with Asian, White, or those of other races; the respective rates were 12.5%, 10.1%, and 14.8% (P < .001).
“Both the preoperative and postoperative models demonstrated high discriminative ability and specificity, reflecting high model sensitivity and a high likelihood that patients with negative predictions did not develop lymphedema,” stated the investigators.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
