关键词: 乳腺癌淋巴水肿, 影响因素分析, 女性, 病例对照研究, 队列研究, 系统评价, Meta分析

Abstract: Background　Breast cancer-related lymphedema （BCRL）is the most common postoperative complication of breast cancer，which cannot be cured clinically at present. Early identification of the risk factors for BCRL may improve the outcome significantly，yet it is still controversial in existing relevant studies，and there is no relevant systematic review in China. Objective　To systematically evaluate the risk factors for BCRL in Chinese women. Methods　We searched the databases of CINAHL，PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，CQVIP，Wanfang Data and SinoMed for articles about the risk factors of BCRL among Chinese women published from inception to June 2020.Two researchers independently screened the studies based on the inclusion and exclusion criteria，extracted data 〔including the first author，time of publication，type of studies，sample size，measurement methods for edema，degree of edema，follow-up time，and BCRL-related factors（age，BMI，hypertension prevalence，lymph node metastasis prevalence，scope of axillary lymph node dissection，having a lymph node dissection，number of lymph nodes dissected，postoperative healing complication，chemotherapy，radiation therapy）〕，and performed risk of bias assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3. Results　31 studies involving 2 618 subjects were included，with moderate or high methodological quality. Meta-analysis showed that older age〔OR=2.59，95%CI（1.95，3.45），P<0.000 01〕，increased BMI〔OR=2.33，95%CI（1.91，2.85），P<0.000 01〕，hypertension〔OR=4.76，95%CI（2.53，8.94），P<0.000 01〕，lymph node metastasis〔OR=1.22，95%CI（1.06，1.39），P=0.005〕，extended axillary lymph node dissection〔OR=2.30，95%CI（1.88，2.81），P<0.000 01〕，having a lymph node dissection〔OR=8.29，95%CI（2.32，29.60），P=0.001〕，number of dissected lymph nodes ≥15〔OR=1.12，95%CI（1.06，1.19），P<0.000 1〕，postoperative healing complication〔OR=4.11，95%CI（3.26，5.17），P<0.000 01〕，chemotherapy〔OR=3.17，95%CI（2.16，4.63），P<0.000 01〕，radiation therapy〔OR=2.69，95%CI（2.32，3.13），P<0.000 01〕were risk factors of BCRL. Conclusion　BCRL among Chinese women may be associated with various risk factors，such as age>40，BMI≥24 kg/m2，hypertension，lymph node metastasis，extended axillary lymph node dissection，having a lymph node dissection，number of dissected axillary lymph nodes ≥15，postoperative healing complication，chemotherapy，and radiation therapy. Due to limited quality and quantity of the included studies，more large-sample prospective cohort studies are required to verify the above conclusion.

Key words: Breast cancer related lymphedema, Root cause analysis, Femininity, Case-control studies, Cohort studies, Systematic review, Meta-analysis