Lymphedema Symptom Trajectories and Patient-Reported Outcomes After Axillary Lymph Node Dissection for Breast Cancer: A Prospective Cohort Study

Objective To characterize lymphedema symptom trajectories and associations with quality of life, anxiety, depression, and upper limb function in Chinese breast cancer survivors after axillary lymph node dissection (ALND). Methods In this prospective cohort study, 332 women undergoing ALND at a cancer center were assessed preoperatively and annually through 24 months using the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), Short Form-36 version 2 (SF-36v2; physical component summary [PCS], mental component summary [MCS]), Hospital Anxiety and Depression Scale (HADS), and Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH). Group-based trajectory modeling (GBTM) identified trajectories; mixed-effects models compared PRO changes across groups, and multivariable regression examined trajectory–PRO associations. Results GBTM identified three trajectories: persistent-low (64.2%), high-stable (19.3%), and low-rapid-progression (16.5%). Significant group-by-time interactions emerged for PCS and DASH, with 12-month interactions for MCS and HADS subscales in the low-rapid-progression group. This group showed less PCS improvement and greater DASH deterioration at 12 and 24 months. For MCS, HADS-A, and HADS-D, interactions were significant at 12 but not 24 months, though outcomes remained worse in this group (physical–psychological dissociation). Low-rapid-progression membership was independently associated with poorer quality of life, greater upper limb impairment, and higher anxiety and depression risk (all P < 0.05). Conclusions Symptom trajectories were independently associated with PROs after ALND. The low-rapid-progression trajectory was associated with poorer quality of life, greater upper limb impairment, and elevated anxiety and depression risk. Early identification may support risk-stratified surveillance, though whether targeted intervention improves PROs requires prospective studies. Trial registration The study was registered in the Chinese Clinical Trial Registry (ChiCTR2200060685).