ImportanceHigher lymphedema rates after axillary lymph node dissection (ALND) have been found in Black and Hispanic women; however, there is poor correlation between subjective symptoms, quality of life (QOL), and measured lymphedema. Additionally, racial and ethnic differences in QOL have been understudied.ObjectiveTo evaluate the association of race and ethnicity with long-term QOL in patients with breast cancer treated with ALND.Design, Setting, and ParticipantsThis cohort study enrolled women aged 18 years and older with breast cancer who underwent unilateral ALND at a tertiary cancer center between November 2016 and March 2020. Preoperatively and at 6-month intervals, arm volume was measured by perometer and QOL was assessed using the Upper Limb Lymphedema-27 (ULL-27) questionnaire, a validated tool for assessing lymphedema that evaluates how arm symptoms affect physical, psychological, and social functioning. Data were analyzed from November 2016 to October 2023.ExposuresBreast surgery and unilateral ALND in the primary setting or after sentinel lymph node biopsy.Main Outcomes and MeasuresScores in each domain of the ULL-27 were compared by race and ethnicity. Factors impacting QOL were identified using multivariable regression analyses.ResultsThe study included 281 women (median [IQR] age, 48 [41-58] years) with breast cancer who underwent unilateral ALND and had at least 6 months of follow-up. Of these, 30 patients (11%) self-identified as Asian individuals, 57 (20%) as Black individuals, 23 (8%) as Hispanic individuals, and 162 (58%) as White individuals; 9 individuals (3%) who did not identify as part of a particular group or who were missing race and ethnicity data were categorized as having unknown race and ethnicity. Median (IQR) follow-up was 2.97 (1.96-3.67) years. The overall 2-year lymphedema rate was 20% and was higher among Black (31%) and Hispanic (27%) women compared with Asian (15%) and White (17%) women (P = .04). Subjective arm swelling was more common among Asian (57%), Black (70%), and Hispanic (87%) women than White (44%) women (P < .001), and lower physical QOL scores were reported by racial and ethnic minority women at nearly every follow-up. For example, at 24 months, median QOL scores were 87, 79, and 80 for Asian, Black, and Hispanic women compared with 92 for White women (P = .003). On multivariable analysis, Asian race (β = –5.7; 95% CI, −9.5 to −1.8), Hispanic ethnicity (β = –10.0; 95% CI, −15.0 to −5.2), and having Medicaid (β = −5.4; 95% CI, −9.2 to −1.7) or Medicare insurance (β = −6.9; 95% CI, −10.0 to −3.4) were independently associated with worse physical QOL (all P < .001).Conclusions and RelevanceFindings of this cohort study suggest that Asian, Black, and Hispanic women experience more subjective arm swelling after unilateral ALND for breast cancer compared with White women. Black and Hispanic women had higher rates of objective lymphedema than their White counterparts. Both minority status and public medical insurance were associated with worse physical QOL. Understanding disparities in QOL after ALND is an unmet need and may enable targeted interventions to improve QOL for these patients.

中文翻译：

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少数族裔妇女腋窝淋巴结清扫术后的生活质量

重要性黑人和西班牙裔女性腋窝淋巴结清扫术 (ALND) 后淋巴水肿发生率较高；然而，主观症状、生活质量 (QOL) 和测量的淋巴水肿之间的相关性较差。此外，种族和民族在生活质量方面的差异尚未得到充分研究。目的评估种族和民族与接受 ALND 治疗的乳腺癌患者的长期生活质量之间的关系。设计、背景和参与者本队列研究纳入了 18 岁及以上患有乳腺癌的女性。 2016 年 11 月至 2020 年 3 月期间在三级癌症中心接受单侧 ALND 的乳腺癌患者。术前和每隔 6 个月，通过压力计测量手臂体积，并使用上肢淋巴水肿-27 (ULL-27) 问卷评估生活质量，一种经过验证的评估淋巴水肿的工具，可评估手臂症状如何影响身体、心理和社会功能。数据分析时间为 2016 年 11 月至 2023 年 10 月。暴露在初级环境中或前哨淋巴结活检后进行乳房手术和单侧 ALND。主要结果和测量 ULL-27 每个领域的分数按种族和民族进行比较。使用多变量回归分析确定影响生活质量的因素。结果该研究包括 281 名患有乳腺癌的女性（中位 [IQR] 年龄，48 [41-58] 岁），她们接受了单侧 ALND，并进行了至少 6 个月的随访。其中，30 名患者 (11%) 自认为是亚洲人，57 名患者 (20%) 是黑人，23 名患者 (8%) 是西班牙裔，162 名患者 (58%) 是白人； 9 名不属于特定群体或缺少种族和民族数据的人 (3%) 被归类为种族和民族未知。中位随访时间 (IQR) 为 2.97 (1.96-3.67) 年。总体 2 年淋巴水肿发生率为 20%，黑人 (31%) 和西班牙裔 (27%) 女性的发病率高于亚洲 (15%) 和白人 (17%) 女性。磷= .04)。主观手臂肿胀在亚裔 (57%)、黑人 (70%) 和西班牙裔 (87%) 女性中比白人 (44%) 女性更常见。磷< .001），少数族裔女性几乎在每次随访中都报告身体生活质量得分较低。例如，在 24 个月时，亚裔、黑人和西班牙裔女性的生活质量中位数分别为 87、79 和 80，而白人女性的中位数为 92。磷=.003）。多变量分析显示，亚洲种族（β = –5.7；95% CI，-9.5 至 -1.8）、西班牙裔（β = –10.0；95% CI，-15.0 至 -5.2）以及享受医疗补助（β = -5.4） ；95% CI，-9.2 至 -1.7）或医疗保险（β = -6.9；95% CI，-10.0 至 -3.4）与较差的身体 QOL 独立相关（所有磷< .001).该队列研究的结论和相关性结果表明，与白人女性相比，亚裔、黑人和西班牙裔女性在乳腺癌单侧 ALND 后主观上手臂肿胀程度更高。黑人和西班牙裔女性的客观淋巴水肿发生率高于白人女性。少数民族身份和公共医疗保险都与较差的身体生活质量相关。了解 ALND 后生活质量的差异是一项未得到满足的需求，可能有助于采取有针对性的干预措施来改善这些患者的生活质量。