Risk Factors for Persistent Lymphedema Following Modified Axillary Lymph Node Dissection in Breast Cancer Patients: A Retrospective Single-Center Study Publisher



Feizi I ; Nikandam B ; Shahabi Z ; Arabzadeh A A
Source: International Journal of Breast Cancer Published:2026

Abstract

Background: Persistent lymphedema (PLE) is a common complication following breast cancer surgery, particularly after axillary lymph node dissection (ALND). It significantly impacts the quality of life and daily functioning of survivors. Understanding the risk factors for PLE is crucial for early detection and effective management. Purpose: This study is aimed at identifying the risk factors for PLE following modified ALND in breast cancer patients, focusing on clinical, surgical, and molecular characteristics. Methods: A retrospective, single-center study was conducted on women who underwent breast cancer surgery between 2018 and 2021. Demographic, clinical, and treatment-related data were collected from medical records. Univariable and multivariable logistic regression analyses were performed to identify risk factors for PLE. Results: Of the 150 patients, 31 (21.4%) developed PLE. Significant risk factors for PLE included metastasis (p < 0.0001), neurovascular invasion (p = 0.029), and the presence of ER-negative (p = 0.032) and Ki-67-positive (p = 0.007) tumors. Surgery type was significantly associated with PLE, with patients who underwent modified radical mastectomy (MRM) having a higher incidence (42.9%) compared with those who had breast-conserving surgery (BCS) (16.0%) (p = 0.002). Chemotherapy also increased the likelihood of PLE (p = 0.001). Multivariable logistic regression revealed that metastasis was the strongest predictor of PLE (OR 11.91, 95% CI: 1.94–73.09, p = 0.007). Conclusions: Metastasis, surgery type, chemotherapy, and molecular factors such as ER and Ki-67 expression showed unadjusted associations with PLE. However, in multivariable logistic regression, metastasis remained the only independent predictor of PLE. These findings support risk-stratified postoperative surveillance, and larger prospective studies with standardized lymphedema measurement are needed to validate independent predictors. Copyright © 2026 Iraj Feizi et al. International Journal of Breast Cancer published by John Wiley & Sons Ltd.