Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

Figures & data

Table I.  Patient and treatment characteristics in the surgery groups.

	Mastectomy (n = 186)	BCT* (n = 77)
Characteristics	Median (Range)	Median (Range)	P-value
Age	55 (35–75)	55 (30–71)	0.32
BMI (before surgery)	26 (19–45)	26 (20–49)	0.46
Observation time (months)	48 (32–87)	44 (34–84)	0.01
	N (%)	N (%)
Tumour pT1	85 (46)	61 (79)
pT2	101 (54)	16 (21)	<0.001
1–9 lymph nodes removed	56 (30)	15 (20)
≥10 ” ” ”	130 (70)	62 (80)	0.08
1–3 metastatic lymph nodes	115 (62)	59 (77)
4–9 metastatic lymph nodes	63 (34)	17 (22)
>10 metastatic lymph nodes	8 (4)	1 (1)	0.057
Manual dose planning	77 (41)	17 (22)
CT dose planning	109 (59)	60 (78)	<0.01
RT † to axilla	81 (44)	18 (23)
RT to axillary apex only	105 (56)	59 (77)	<0.01
Got chemotherapy	151 (81)	60 (78)	0.5

*Breast-conserving therapy, † Radiotherapy.

Table II.  A and II B. Lymphedema, impaired shoulder function and other symptoms in the surgery groups.

	Mastectomy (n = 186)	BCT* (n = 77)
Variable	N (%)	N (%)	P-value
A. Findings from clinical examination
Lymphedema	37 (20)	6 (8)	0.02
Lymphedema
1–3 metastatic nodes	17/115 (15)	5/59 (8)	0.34
4–9 metastatic nodes	15/63 (24)	1/17 (6)	0.17
10–16 metastatic nodes	5/8 (62)	0/1 (0)	0.44
ROM† reduction ≥25°
Flexion of arm	42 (24)	5 (7)	<0.01
ROM reduction ≥25°
Abduction of arm	66 (38)	12 (18)	<0.01
B. Findings from questionnaire‡
How swollen is your arm?	53 (29)	10 (13)	<0.01
How much pain do you have in your arm?	59 (32)	10 (13)	<0.01
How much pain do you have in your shoulder?	58 (32)	9 (12)	0.001
How stiff is your arm?	35 (19)	7 (9)	0.05
How stiff is your shoulder?	48 (26)	6 (8)	0.001
How well can you use your arm compared to before your surgery?	105 (58)	25 (33)	<0.001
How numb is your arm?	42 (23)	13 (18)	0.25
How well can you move your arm compared to before your surgery?	60 (33)	9 (12)	0.001

*Breast-conserving therapy, † Range of Motion.

‡Scores indicate persistent moderate/severe symptoms.

Table III.  Associations of relevant variables and lymphoedema in the total sample.

	Univariate analysis			Multivariate analysis
Variable	OR	95% CI	P	OR	95% CI	P
Age at survey	1.02	0.98–1.06	0.3
Observation time	1.02	0.99–1.05	0.2
BCT* (ref)	1.00
Mastectomy	2.94	1.2–7.3	0.02	2.75	1.03–7.33	0.04
CT dose planning (ref)	1.00
Manual dose planning	1.7	0.87–3.2	0.1
RT† to apex of axilla (ref)	1.00
RT to axilla	1.12	0.56–2.22	0.75
pT1 (ref)	1.00
pT2	1.72	0.89–3.33	0.1	1.18	0.58–2.4	0.64
Metastatic lymph nodes	1.19	1.08–1.3	0.001	1.14	1.03–1.27	0.02
No of lymph nodes removed	1.08	1.005–1.15	0.04	1.05	0.98–1.14	0.17
Body mass index	1.11	1.04–1.18	<0.01	1.11	1.04–1.19	<0.01

Impaired shoulder function is defined as ROM reduction ≥ 25.

* Breast-conserving therapy, † Radiotherapy.

Table IV.  Associations of relevant variables and impaired shoulder abduction as dependent variable.

	Univariate analysis			Multivariate analysis
Variable	OR	95% CI	P	OR	95% CI	P
Age	1.03	0.99–1.06	0.13
Observation time	1.04	1.02–1.07	0.001	1.04	1.006–1.09	0.02
BCT* (ref)	1.00
Mastectomy	2.75	1.37–5.5	0.004	2.3	1.06–4.98	0.04
CT dose planning (ref)	1.00
Manual dose planning	2.1	1.2–3.67	0.008	0.8	0.34–1.86	0.61
RT to apex of axilla (ref)	1.00
RT † to axilla	2.22	1.25–3.88	0.006	1.19	0.54–2.6	0.67
pT1 (ref)	1.00
pT2	1.5	0.87–2.58	0.14	1.4	0.75–2.6	0.29
Metastatic lymph nodes	0.98	0.9–1.09	0.64
Lymph nodes removed	0.92	0.85–0.98	0.01	0.94	0.87–1.02	0.11
Body mass index	1.1	1.03–1.17	0.004	1.12	1.05–1.2	0.001

Impaired shoulder function is defined as ROM reduction ≥ 25.

*Breast-conserving therapy, † Radiotherapy.

Table V.  Associations of relevant variables and impaired shoulder flexion as dependent variable

	Univariate analysis			Multivariate analysis
Variable	OR	95% CI	P	OR	95% CI	P
Age	1.03	0.98–1.08	0.2
Observation time	1.06	1.03–1.1	<0.001	1.03	0.99–1.08	0.13
BCT* (ref)	1.00
Mastectomy	4.14	1.6–10.9	0.004	3.3	1.2–9.14	0.02
CT dose planning (ref)	1.00
Manual dose planning	4.98	2.5–9.9	<0.001	2.5	0.93–6.1	0.06
RT to apex of axilla (ref)	1.00
RT† to axilla	2.97	1.54–5.7	0.001	1.22	0.51–2.75	0.64
pT1 (ref)	1.00
pT2	0.83	0.4–1.58	0.6
Metastatic lymph nodes	1.05	0.95–1.2	0.3
Lymph nodes removed	0.93	0.86–1.01	0.09
Body mass index	1.08	1.01–1.16	0.02	1.09	1.02–1.18	0.02

Impaired shoulder function is defined as ROM reduction ≥ 25.

*Breast conserving therapy, † Radiotherapy.