| Objective To construct a multimodal precision assessment system based on bioimpedance spectroscopy (BIS) and serum biomarkers, evaluate the clinical efficacy of topical application of Yiqi Huoxue Xiaozhong Formula combined with acupoint massage for the treatment of breast cancer-related upper limb lymphedema (BCRL), explore its molecular mechanism, and develop a treatment efficacy prediction model. Methods A total of 240 patients with BCRL were enrolled and randomly assigned to a control group (CDT, n=80), a topical Chinese herbal application group (CDT + herbal application, n=80), and a combination therapy group (CDT + herbal application + acupoint massage, n=80). The intervention lasted 28 days, with a follow?up period of 6 months. The primary outcome measure was the change in BIS L?Dex score. Secondary outcome measures included the weighted mean of arm circumference, DASH score, LBCQ score, VAS score, and serum levels of TNF?α, IL?6, TGF?β1, and VEGF?C. ROC curve and decision curve analyses were used to construct a treatment efficacy prediction model. Results A total of 234 patients completed the full intervention, with a dropout rate of 2.50%. The reduction in L?Dex score in the combination therapy group (-15.4±4.8) was significantly greater than that in the herbal application group (-10.0±4.1) and the control group (-4.6±3.3). L?Dex normalized in 42.5% of patients in the combination therapy group. VEGF?C increased by 36.1% and TGF?β1 decreased by 36.8% in the combination therapy group. At the 6?month follow?up, the efficacy maintenance rate in the combination therapy group was 90.3%. Good efficacy was defined as ΔL-Dex ≥ 10. Among the 234 patients who completed follow-up, the actual incidence of good efficacy was 47.86%, with values of 74.36% in the combination therapy group, 49.37% in the traditional Chinese medicine topical application group, and 19.48% in the control group. The AUC of the constructed efficacy prediction model was 0.881. Conclusion Topical application of Yiqi Huoxue Xiaozhong Formula combined with acupoint massage significantly improves BCRL through a bidirectional regulatory mechanism of “promoting lymphangiogenesis, anti?inflammation, and anti?fibrosis”. The developed efficacy prediction model provides a quantitative tool for individualized treatment decision?making. |