为探究现代综合治疗后，早期乳腺癌患者患乳腺癌相关淋巴水肿（BCRL）和上肢功能障碍（UED）的风险因素，比较不同治疗策略的毒性。对我中心2017年至2020年行辅助放疗的1369名pT1-3N0-1M0女性乳腺癌患者进行回顾性研究。通过Norman和QuickDASH问卷鉴定患者是否患有BCRL和UED。评估BCRL和UED的发病率、严重程度和风险因素。 经过25个月的中位随访，共有249名患者出现BCRL。腋窝淋巴结清扫（ALND）、切除淋巴结数量增多、右侧乳腺癌和含RNI的低剂量分段放疗被发现是有显著风险的因素（所有p值均<0.05）。前哨淋巴结活检（SLNB）+区域淋巴结放射治疗（RNI）组患有BCRL的风险显著低于ALND+RNI组（10.8% vs. 32.5%，HR=0.426，p=0.020），而ALND vs. ALND+RNI或SLNB vs. SLNB+RN之间则没有显著差异。共有193名患者出现UED，其中ALND（p=0.02）是唯一的重要风险因素。 SLNB+RNI组与ALND+RNI组相比，患有UED的风险显著降低（7.5% vs. 23.9%，HR=0.260，p=0.001），而SLNB vs. SLNB+RNI或ALND vs. ALND+RNI之间则没有显著差异。侵袭性ALND仍然是BCRL和UED的主要风险因素，而RNI则不是。因此，用量身定制的放疗代替ALND将是早期乳腺癌患者有效的预防策略。版权所有©2023 Elsevier Ltd. 。保留所有权利。

To explore the risk factors for breast cancer-related lymphedema (BCRL) and upper extremity dysfunction (UED) in patients with early breast cancer after modern comprehensive treatment and to compare the toxicity of different treatment strategies.From 2017 to 2020, a total of 1369 female patients with pT1-3N0-1M0 breast cancer who underwent adjuvant radiotherapy in our centre were retrospectively reviewed. BCRL and UED were identified by the Norman and QuickDASH questionnaires. The incidence, severity and risk factors for BCRL and UED were evaluated.After a median follow-up of 25 months, a total of 249 patients developed BCRL; axillary lymph node dissection (ALND), increased number of dissected nodes, right-sided and hypofractionated radiotherapy containing RNI were found to be significant risk factors (all p values < 0.05). The sentinel lymph node biopsy (SLNB)+ regional nodal irradiation (RNI) group had a significantly lower BCRL risk than the ALND + RNI group (10.8% vs. 32.5%, HR = 0.426, p = 0.020), while there was no significant difference between ALND vs. ALND + RNI or SLNB vs. SLNB + RNI. A total of 193 patients developed UED, and ALND (p = 0.02) was the only significant risk factor. The SLNB + RNI group had a significantly decreased risk of UED compared with the ALND + RNI group (7.5% vs. 23.9%, HR = 0.260, p = 0.001), and there was no significant difference between SLNB vs. SLNB + RNI or ALND vs. ALND + RNI.Aggressive ALND remains the primary risk factor for BCRL and UED while RNI does not. Thus, replacing ALND with tailored radiotherapy would be an effective preventive strategy in early breast cancer patients.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.