Analysis of influencing factors and construction of a prediction model for postoperative upper limb lymphedema in patients undergoing radical mastectomy for breast cancer
Xu Changjia
Wang Lili
Wu Yan
Pan Jun
Ji Qiuchen
Zhu Kanglin
Tian Yuan
Abstract：Objective To explore the influencing factors of postoperative upper limb lymphedema(ULL)in patients undergoing radical mastectomy for breast cancer and to construct a risk prediction model.Methods This study selected 206 patients who underwent radical mastectomy for breast cancer at the First Affiliated Hospital with Nanjing Medical University from January 2022 to October 2023 as the research participants.After 1 year of follow-up,the patients were allocated to a ULL group(n=84)and a non-ULL group(n=122)based on the presence or absence of postoperative ULL.Binary logistic regression analysis was used to explore the influencing factors of postoperative ULL in these patients,and based on this,a nomogram model was constructed.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the nomogram model for postoperative ULL in patients undergoing radical mastectomy for breast cancer.Results The average age of the breast cancer patients undergoing radical mastectomy was(57.46±6.59)years;the average body mass index(BMI)was(23.61±4.45)kg/m2.Binary logistic regression analysis showed that BMI＞30 kg/m2(OR=2.392;95％CI:1.603-3.567),co-morbid hypertension(OR=1.921;95％CI:1.369-2.697),clinical stage Ⅲ(OR=2.158;95％CI:1.507-3.088),num-ber of lymph nodes dissected ≥10(OR=3.077;95％CI:1.976-4.792),postoperative radiotherapy(OR=2.593;95％CI:1.705-3.945),and postoperative incision infection(OR=2.724;95％CI:1.794-4.135)were risk factors for postoperative ULL in patients undergoing radical mastectomy for breast cancer(P＜0.05).A nomogram model for predicting postoperative ULL in these patients was constructed.The results showed that the concordance index(C-index)was 0.839(95％CI:0.786-0.892).The area under the curve(AUC)of the nomogram model for predicting postoperative ULL was 0.879(95％CI:0.826-0.932),with a specificity of 67.59％and a sensitivity of 92.03％.Conclusion Risk factors for postoperative ULL in patients under-going radical mastectomy for breast cancer include BMI＞30 kg/m2,comorbid hypertension,and clinical stage Ⅲ.The nomogram model constructed based on these factors has high predictive value.
Keywords：Radical mastectomyUpper limb lymphedemaInfluencing factorsNomogramPrediction model
Publication Date：2025-05-20
Online Publishing Date：2025-09-04(First online date of this platform, not the publication date of the document)
Pages：6( 78-83 )