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1.中南大学湘雅三医院护理部,长沙 410013
2.中南大学湘雅三医院门诊综合护理单元,长沙 410013
3.中南大学湘雅三医院急诊科,长沙 410013
4.中南大学湘雅护理学院,长沙 410013
5.吉林医药学院护理学院, 吉林 132013
6.中南大学湘雅三医院麻醉科,长沙 410013
KANG Dan, Email: 3556884878@qq.com, ORCID: 0009-0001-7540-4179
YAN Huang, Senior nurse, Email: Huangnn2021@163.com, ORCID: 0000-0003-4646-0814
WANG Ling, Professor, Email: 1322788113@qq.com, ORCID: 0009-0009-5954-9341
收稿:2025-08-19,
纸质出版:2026-02-28
康丹, 严煌, 卢庆, 陈海兵, 王玲. 紫杉醇类辅助化疗对乳腺癌相关淋巴水肿的影响:一项倾向性评分匹配研究[J]. 中南大学学报(医学版), 2026, 51(2): 256-265.
KANG Dan, YAN Huang, LU Qing, CHEN Haibing, WANG Ling. Effect of taxane-based adjuvant chemotherapy on breast cancer-related lymphedema: A propensity score matching study[J]. Journal of Central South University. Medical Science, 2026, 51(2): 256-265.
康丹, 严煌, 卢庆, 陈海兵, 王玲. 紫杉醇类辅助化疗对乳腺癌相关淋巴水肿的影响:一项倾向性评分匹配研究[J]. 中南大学学报(医学版), 2026, 51(2): 256-265. DOI:10.11817/j.issn.1672-7347.2026.250474.
KANG Dan, YAN Huang, LU Qing, CHEN Haibing, WANG Ling. Effect of taxane-based adjuvant chemotherapy on breast cancer-related lymphedema: A propensity score matching study[J]. Journal of Central South University. Medical Science, 2026, 51(2): 256-265. DOI:10.11817/j.issn.1672-7347.2026.250474.
目的
2
乳腺癌相关淋巴水肿(breast cancer-related lymphedema,BCRL)是乳腺癌治疗的常见并发症,既往研究认为其与辅助化疗有关。但由于混杂因素干扰,辅助化疗中常用的紫杉醇类药物是否独立影响BCRL尚存争议。倾向性评分匹配(propensity score matching,PSM)可有效控制混杂偏倚,本研究旨在采用该法探讨紫杉醇类辅助化疗与BCRL之间的关联。
方法
2
本研究为回顾性设计,数据来自中南大学湘雅三医院的电子病历系统。BCRL的诊断依据为患肢周长的客观测量结果。紫杉醇类辅助化疗定义为含多西他赛、紫杉醇或白蛋白结合型紫杉醇的化疗方案。通过PSM控制混杂因素,并对匹配后样本进行Logistic回归分析,评估紫杉醇类化疗与BCRL的关系。
结果
2
本研究共纳入1 494例患者。PSM前,紫杉醇类辅助化疗与BCRL未表现出显著相关性(
OR
=0.979,95%
CI
0.587~1.580;
P
=0.932)。PSM后共匹配363例,结果仍无统计学意义(
OR
=0.959,95%
CI
0.540~1.672;
P
=0.885)。
结论
2
无论是否控制其他已知危险因素,紫杉醇类辅助化疗均非BCRL的独立危险因素。未来需开展多中心、前瞻性研究进一步验证。
Objective
2
Breast cancer-related lymphedema (BCRL) is a common complication of breast cancer treatment. Previous studies have suggested an association between BCRL and adjuvant chemotherapy; however
whether taxane-based regimens independently influence the risk of BCRL remains controversial due to potential confounding factors. Propensity score matching (PSM) can effectively reduce confounding bias. This study aims to investigate the association between taxane-based adjuvant chemotherapy and BCRL using PSM.
Methods
2
This retrospective study was conducted using data from the electronic medical record system of Xiangya Third Hospital
Central South University. BCRL was diagnosed based on objective measurements of limb circumference. Taxane-based adjuvant chemotherapy was defined as chemotherapy regimens including docetaxel
paclitaxel
or albumin-bound paclitaxel. PSM was applied to control for potential confounders
followed by Logistic regression analysis in the matched cohort to evaluate the association between taxane-based chemotherapy and BCRL.
Results
2
A total of 1 494 patients were included in this study. Before PSM
taxane-based adjuvant chemotherapy was not significantly associated with BCRL (
OR
=0.979
95%
CI
0.587 to 1.580;
P
=0.932). After PSM
363 matched patients were obtained
and the association remained non-significant (
OR
=0.959
95%
CI
0.540 to 1.672;
P
=0.885).
Conclusion
2
Taxane-based adjuvant chemotherapy is not an independent risk factor for BCRL
regardless of adjustment for known confounding factors. Further multicenter
prospective studies are warranted to further validate these findings.
Martínez-Jaimez P , Armora Verdú M , Forero CG , et al . Breast cancer-related lymphoedema: Risk factors and prediction model [J ] . J Adv Nurs , 2022 , 78 ( 3 ): 765 - 775 . https://doi.org/10.1111/jan. 15005 https://doi.org/10.1111/jan.15005 .
DeSantis CE , Ma JM , Gaudet MM , et al . Breast cancer statistics, 2019 [J ] . CA Cancer J Clin , 2019 , 69 ( 6 ): 438 - 451 . https://doi.org/10.3322/caac.21583 https://doi.org/10.3322/caac.21583 .
Asdourian MS , Skolny MN , Brunelle C , et al . Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis [J/OL ] . Lancet Oncol , 2016 , 17 ( 9 ): e392 - e405 [ 2025-08-01 ] . https://doi.org/10.1016/S1470-2045(16)30204-2 https://doi.org/10.1016/S1470-2045(16)30204-2 .
DiSipio T , Rye S , Newman B , et al . Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis [J ] . Lancet Oncol , 2013 , 14 ( 6 ): 500 - 515 . https://doi. org/10.1016/S1470-2045(13)70076-7 https://doi.org/10.1016/S1470-2045(13)70076-7 .
He L , Qu H , Wu Q , et al . Lymphedema in survivors of breast cancer (Review) [J ] . Oncol Lett , 2020 : 2085 - 2096 . https://doi.org/10.3892/ol.2020.11307 https://doi.org/10.3892/ol.2020.11307 .
McEvoy MP , Ravetch E , Patel G , et al . Prevention of breast cancer-related lymphedema [J ] . Clin Breast Cancer , 2021 , 21 ( 2 ): 128 - 142 . https://doi.org/10.1016/j.clbc.2021.02.009 https://doi.org/10.1016/j.clbc.2021.02.009 .
Dayan JH , Ly CL , Kataru RP , et al . Lymphedema: pathogenesis and novel therapies [J ] . Annu Rev Med , 2018 , 69 : 263 - 276 . https://doi.org/10.1146/annurev-med-060116-022900 https://doi.org/10.1146/annurev-med-060116-022900 .
Boyages J , Xu Y , Kalfa S , et al . Financial cost of lymphedema borne by women with breast cancer: Financial cost of lymphedema [J ] . Psycho Oncol , 2017 , 26 ( 6 ): 849 - 855 . https://doi. org/10.1002/pon.4239 https://doi.org/10.1002/pon.4239 .
Dominick SA , Natarajan L , Pierce JP , et al . The psychosocial impact of lymphedema-related distress among breast cancer survivors in the WHEL Study [J ] . Psycho Oncol , 2014 , 23 ( 9 ): 1049 - 1056 . https://doi.org/10.1002/pon.3510 https://doi.org/10.1002/pon.3510 .
De Vrieze T , Gebruers N , Nevelsteen I , et al . Breast cancer-related lymphedema and its treatment: how big is the financial impact? [J ] . Support Care Cancer , 2021 , 29 ( 7 ): 3801 - 3813 . https://doi.org/10.1007/s00520-020-05890-3 https://doi.org/10.1007/s00520-020-05890-3 .
McDuff SGR , Mina AI , Brunelle CL , et al . Timing of lymphedema after treatment for breast cancer: when are patients most At risk? [J ] . Int J Radiat Oncol , 2019 , 103 ( 1 ): 62 - 70 . https://doi.org/10.1016/j.ijrobp.2018.08.036 https://doi.org/10.1016/j.ijrobp.2018.08.036 .
Ferguson CM , Swaroop MN , Horick N , et al . Impact of ipsilateral blood draws, injections, blood pressure measurements, and air travel on the risk of lymphedema for patients treated for breast cancer [J ] . J Clin Oncol , 2016 , 34 ( 7 ): 691 - 698 . https://doi.org/10.1200/JCO.2015.61.5948 https://doi.org/10.1200/JCO.2015.61.5948 .
Fu M , Axelrod D , Guth A , et al . Patterns of obesity and lymph fluid level during the first year of breast cancer treatment: a prospective study [J ] . J Pers Med , 2015 , 5 ( 3 ): 326 - 340 . https://doi.org/10.3390/jpm5030326 https://doi.org/10.3390/jpm5030326 .
Schmitz KH , Troxel AB , Dean LT , et al . Effect of home-based exercise and weight loss programs on breast cancer-related lymphedema outcomes among overweight breast cancer survivors: the WISER survivor randomized clinical trial [J ] . JAMA Oncol , 2019 , 5 ( 11 ): 1605 - 1613 . https://doi.org/10.1001/jamaoncol.2019. 2109 https://doi.org/10.1001/jamaoncol.2019.2109 .
McLaughlin SA , Brunelle CL , Taghian A . Breast cancer-related lymphedema: risk factors, screening, management, and the impact of locoregional treatment [J ] . J Clin Oncol , 2020 , 38 ( 20 ): 2341 - 2350 . https://doi.org/10.1200/jco.19.02896 https://doi.org/10.1200/jco.19.02896 .
Cariati M , Bains SK , Grootendorst MR , et al . Adjuvant taxanes and the development of breast cancer-related arm lymphoedema [J ] . Br J Surg , 2015 , 102 ( 9 ): 1071 - 1078 . https://doi.org/10. 1002/bjs.9846 https://doi.org/10.1002/bjs.9846 .
Swaroop MN , Ferguson CM , Horick NK , et al . Impact of adjuvant taxane-based chemotherapy on development of breast cancer-related lymphedema: results from a large prospective cohort [J ] . Breast Cancer Res Treat , 2015 , 151 ( 2 ): 393 - 403 . https://doi.org/10.1007/s10549-015-3408-1 https://doi.org/10.1007/s10549-015-3408-1 .
Zhu W , Li D , Li X , et al . Association between adjuvant docetaxel-based chemotherapy and breast cancer-related lymphedema [J ] . Anti Cancer Drugs , 2017 , 28 ( 3 ): 350 - 355 . https://doi.org/10.1097/cad.0000000000000468 https://doi.org/10.1097/cad.0000000000000468 .
Henderson IC , Berry DA , Demetri GD , et al . Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer [J ] . J Clin Oncol , 2003 , 21 ( 6 ): 976 - 983 . https://doi.org/10. 1200/JCO.2003.02.063 https://doi.org/10.1200/JCO.2003.02.063 .
Martín M , Seguí MA , Antón A , et al . Adjuvant docetaxel for high-risk, node-negative breast cancer [J ] . N Engl J Med , 2010 , 363 ( 23 ): 2200 - 2210 . https://doi.org/10.1056/nejmoa0910320 https://doi.org/10.1056/nejmoa0910320 .
Brønstad A , Berg A , Reed RK . Effects of the taxanes paclitaxel and docetaxel on edema formation and interstitial fluid pressure [J/OL ] . Am J Physiol Heart Circ Physiol , 2004 , 287 ( 2 ): H963 - H968 [ 2025-08-01 ] . https://doi.org/10.1152/ajpheart.01052.2003 https://doi.org/10.1152/ajpheart.01052.2003 .
Goble S , Bear HD . Emerging role of taxanes in adjuvant and neoadjuvant therapy for breast cancer The potential and the questions [J ] . Surg Clin N Am , 2003 , 83 ( 4 ): 943 - 971 . https://doi.org/10.1016/S0039-6109(03)00071-9 https://doi.org/10.1016/S0039-6109(03)00071-9 .
Jung SY , Shin KH , Kim M , et al . Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients [J ] . Breast Cancer Res Treat , 2014 , 148 ( 1 ): 91 - 98 . https://doi.org/10. 1007/s10549-014-3137-x https://doi.org/10.1007/s10549-014-3137-x .
Thiese MS . Observational and interventional study design types; an overview [J ] . Biochem Med , 2014 , 24 ( 2 ): 199 - 210 . https://doi.org/10.11613/BM.2014.022 https://doi.org/10.11613/BM.2014.022 .
Grosu S , Rospleszcz S , Hartmann F , et al . Associated factors of white matter hyperintensity volume: a machine-learning approach [J ] . Sci Rep , 2021 , 11 : 2325 . https://doi.org/10.1038/s41598-021- 81883-4 https://doi.org/10.1038/s41598-021-81883-4 .
Austin PC . An introduction to propensity score methods for reducing the effects of confounding in observational studies [J ] . Multivar Behav Res , 2011 , 46 ( 3 ): 399 - 424 . https://doi.org/10. 1080/00273171.2011.568786 https://doi.org/10.1080/00273171.2011.568786 .
Kurth T , Walker AM , Glynn RJ , et al . Results of multivariable logistic regression, propensity matching, propensity adjustment, and propensity-based weighting under conditions of nonuniform effect [J ] . Am J Epidemiol , 2006 , 163 ( 3 ): 262 - 270 . https://doi.org/10.1093/aje/kwj047 https://doi.org/10.1093/aje/kwj047 .
Morris MJ , Loriot Y , Sweeney CJ , et al . Radium -223 in combination with docetaxel in patients with castration-resistant prostate cancer and bone metastases: a phase 1 dose escalation/randomised phase 2a trial [J ] . Eur J Cancer , 2019 , 114 : 107 - 116 . https://doi.org/10.1016/j.ejca.2019.04.007 https://doi.org/10.1016/j.ejca.2019.04.007 .
Yoo JN , Cheong YS , Min YS , et al . Validity of quantitative lymphoscintigraphy as a lymphedema assessment tool for patients with breast cancer [J ] . Ann Rehabil Med , 2015 , 39 ( 6 ): 931 . https://doi.org/10.5535/arm.2015.39.6.931 https://doi.org/10.5535/arm.2015.39.6.931 .
Bar Ad V , Cheville A , Solin LJ , et al . Time course of mild arm lymphedema after breast conservation treatment for early-stage breast cancer [J ] . Int J Radiat Oncol , 2010 , 76 ( 1 ): 85 - 90 . https://doi.org/10.1016/j.ijrobp.2009.01.024 https://doi.org/10.1016/j.ijrobp.2009.01.024 .
Morgan CJ . Reducing bias using propensity score matching [J ] . J Nucl Cardiol , 2018 , 25 ( 2 ): 404 - 406 . https://doi.org/10. 1007/s12350-017-1012-y https://doi.org/10.1007/s12350-017-1012-y .
MacKey JR , Martin M , Pienkowski T , et al . Adjuvant docetaxel, doxorubicin, and cyclophosphamide in node-positive breast cancer: 10-year follow-up of the phase 3 randomised BCIRG 001 trial [J ] . Lancet Oncol , 2013 , 14 ( 1 ): 72 - 80 . https://doi.org/10.1016/S1470-2045(12)70525-9 https://doi.org/10.1016/S1470-2045(12)70525-9 .
Giordano SH , Lin YL , Kuo YF , et al . Decline in the use of anthracyclines for breast cancer [J ] . J Clin Oncol , 2012 , 30 ( 18 ): 2232 - 2239 . https://doi.org/10.1200/jco.2011.40.1273 https://doi.org/10.1200/jco.2011.40.1273 .
Semb KA , Aamdal S , Oian P . Capillary protein leak syndrome appears to explain fluid retention in cancer patients who receive docetaxel treatment [J ] . J Clin Oncol , 1998 , 16 ( 10 ): 3426 - 3432 . https://doi.org/10.1200/JCO.1998.16.10.3426 https://doi.org/10.1200/JCO.1998.16.10.3426 .
Béhar A , Pujade-Lauraine E , Maurel A , et al . The pathophysiological mechanism of fluid retention in advanced cancer patients treated with docetaxel, but not receiving corticosteroid comedication [J ] . Brit J Clinical Pharma , 1997 , 43 ( 6 ): 653 - 658 . https://doi.org/10.1046/j.1365-2125.1997.00613.x https://doi.org/10.1046/j.1365-2125.1997.00613.x .
Tokumoto H , Akita S , Nakamura R , et al . Investigation of the association between breast cancer-related lymphedema and the side effects of taxane-based chemotherapy using indocyanine green lymphography [J ] . Lymphatic Res Biol , 2022 , 20 ( 6 ): 612 - 617 . https://doi.org/10.1089/lrb.2021.0065 https://doi.org/10.1089/lrb.2021.0065 .
Jeong SH , Chun SM , Lee H , et al . Association between chemotherapy and the risk of developing breast cancer-related lymphedema: a nationwide retrospective cohort study [J ] . Support Care Cancer , 2025 , 33 ( 2 ): 143 . https://doi.org/10. 1007/s00520-025-09169-3 https://doi.org/10.1007/s00520-025-09169-3 .
Jung AW , Juhel B , Smith LH , et al . Abstract P1 - 12 -05: The impact of adjuvant chemotherapy, taxanesincluding, on breast cancer-related lymphedema risk[J/OL ] . Cancer Res , 2023 , 83 ( 5_Supplement ): P1 - 12 - 05 [ 2025-08-01 ] . https://doi.org/10.1158/1538-7445.SABCS22-P1-12-05 https://doi.org/10.1158/1538-7445.SABCS22-P1-12-05 .
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