乳腺癌保乳术后乳房水肿危险因素分析及风险预测模型研究

Analysis of Risk Factors and Risk Prediction Model of Breast Edema after Breast-Conserving Surgery for Breast Cancer

摘要: 目的：明确乳腺癌保乳术后乳房水肿发生率及独立危险因素，构建并初步验证风险预测列线图，为临床早期识别高危人群、实施个体化干预提供参考。方法：连续纳入2023年11月至2025年11月包头市肿瘤医院200例保乳手术女性乳腺癌患者，明确乳房水肿诊断标准，收集相关临床及心理数据；经单因素分析、LASSO回归变量降维及多因素Logistic回归筛选独立危险因素，构建列线图，通过Bootstrap重采样及多种方法评估模型性能。结果：200例患者中50例发生乳房水肿，发生率25.0%，中位发生时间8个月；BMI、乳房CTV体积等7项为独立危险因素(均P < 0.05)，构建的列线图AUC为0.866，校准度、稳定性良好，2%~8%阈值范围内有临床净获益。结论：乳腺癌保乳术后乳房水肿发生率较高，上述7项为独立危险因素，其列线图可作为临床个体化风险评估及早期干预的参考。

Abstract: Objective: To determine the incidence of breast edema and its independent risk factors after breast-conserving surgery for breast cancer, construct and preliminarily validate a risk prediction column chart, and provide a reference for early clinical identification of high-risk populations and implementation of individualized interventions. Methods: A total of 200 female breast cancer patients who underwent breast-conserving surgery at Baotou Cancer Hospital from November 2023 to November 2025 were consecutively enrolled. Diagnostic criteria for breast edema were established, and relevant clinical and psychological data were collected. Independent risk factors were screened through univariate analysis, LASSO regression variable dimensionality reduction, and multivariate logistic regression. A column chart was constructed, and model performance was evaluated using Bootstrap resampling and multiple methods. Results: Among the 200 patients, 50 developed breast edema, with an incidence rate of 25.0% and a median occurrence time of 8 months. Seven factors, including BMI and breast CTV volume, were identified as independent risk factors (all P < 0.05). The AUC of the constructed column chart was 0.866, demonstrating good calibration and stability, with clinical net benefit within the 2%~8% threshold range. Conclusion: The incidence of breast edema after breast-conserving surgery for breast cancer is relatively high, and the aforementioned seven factors are independent risk factors. The column chart can serve as a reference for clinical individualized risk assessment and early intervention.