Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study

Abstract

BackgroundLower limb lymphedema (LLL) is a chronic and incapacitating condition afflicting patients who undergo lymphadenectomy for gynecologic cancer. This study aimed to identify risk factors for LLL and to develop a prediction model for its occurrence.MethodsPelvic lymphadenectomy (PLA) with or without para-aortic lymphadenectomy (PALA) was performed on 366 patients with gynecologic malignancies at Yaizu City Hospital between April 2002 and July 2014; we retrospectively analyzed 264 eligible patients. The intervals between surgery and diagnosis of LLL were calculated; the prevalence and risk factors were evaluated using the Kaplan-Meier and Cox proportional hazards methods. We developed a prediction model with which patients were scored and classified as low-risk or high-risk.ResultsThe cumulative incidence of LLL was 23.1% at 1 year, 32.8% at 3 years, and 47.7% at 10 years post-surgery. LLL developed after a median 13.5 months. Using regression analysis, body mass index (BMI) ≥25 kg/m2 (hazard ratio [HR], 1.616; 95% confidence interval [CI], 1.030–2.535), PLA + PALA (HR, 2.323; 95% CI, 1.126–4.794), postoperative radiation therapy (HR, 2.469; 95% CI, 1.148–5.310), and lymphocyst formation (HR, 1.718; 95% CI, 1.120–2.635) were found to be independently associated with LLL; age, type of cancer, number of lymph nodes, retroperitoneal suture, chemotherapy, lymph node metastasis, herbal medicine, self-management education, or infection were not associated with LLL. The predictive score was based on the 4 associated variables; patients were classified as high-risk (scores 3–6) and low-risk (scores 0–2). LLL incidence was significantly greater in the high-risk group than in the low-risk group (HR, 2.19; 95% CI, 1.440–3.324). The cumulative incidence at 5 years was 52.1% [95% CI, 42.9–62.1%] for the high-risk group and 28.9% [95% CI, 21.1–38.7%] for the low-risk group. The area under the receiver operator characteristics curve for the prediction model was 0.631 at 1 year, 0.632 at 3 years, 0.640 at 5 years, and 0.637 at 10 years.ConclusionBMI ≥25 kg/m2, PLA + PALA, lymphocyst formation, and postoperative radiation therapy are significant predictive factors for LLL. Our prediction model may be useful for identifying patients at risk of LLL following lymphadenectomy. Providing an intensive therapeutic strategy for high-risk patients may help reduce the incidence of LLL and conserve the quality of life.

Psychometric evaluation of a Chinese version of Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema in women with gynaecological cancer surgery

“…It is possible that only few participants of the study reported the infection symptoms of the lower limbs (4%), which may decrease the item homogeneity. The rate of limb skin infection is similar to that reported by Kuroda et al, () study that the prevalence rate of skin infection for lower limbs is 4%–8% among gynaecological cancer women (Kuroda et al, ). However, the rate of limb infection is lower than that (10%) reported in the study of Devoogdt et al ().…”

“…Lower limb lymphoedema (LLL), a chronic and progressive condition, is a common complication among women with gynaecological cancer who undergo lymphadenectomy or radiation therapy (Lockwood‐Rayermann, ). The LLL has a variation in its time of occurrence, with the median time after surgery from 6 months to 13.5 years (Abu‐Rustum et al, ; Kuroda et al, ; Ohba et al, ). The prevalence rate of LLL ranged from 11% to 38% in gynaecological cancer patient (Achouri et al, ; Tada, Teramukai, Fukushima, & Sasaki, ; Todo et al, ).…”

“…The prevalence rate of LLL ranged from 11% to 38% in gynaecological cancer patient (Achouri et al, ; Tada, Teramukai, Fukushima, & Sasaki, ; Todo et al, ). The cumulative incidence of LLL inclines during the post‐surgery period, estimated 23.1% at 1 year and 47.7% at 10 years post‐surgery (Kuroda et al, ). In Taiwan, the prevalence rate of LLL within 2 years after surgery is 24% among the survivors of cervical cancer with radiation therapy (Hsu et al, ).…”

Prävalenz von Komorbiditäten bei Lymphödem-Erkrankungen

“…Davon konnten nach inhaltlicher Analyse der Abstracts 45 Artikel identifiziert werden, die sich vordringlich mit ätiologischen Faktoren, Komorbiditäten oder Folgeerkrankungen des Lymphödems befassen. 24 Arbeiten (53 %) davon thematisierten sekundäre Lymphödeme nach Mammakarzinom , 15 Arbeiten (33 %) sekundäre Lymphödeme nach anderen gynäkologischen Malignomen [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. 3 Arbeiten (7 %) betrachteten sekundäre Lymphödeme bei nichtgynäkologischen Erkrankungen (Kopf-Hals-Karzinom, Melanom, Lymphangioleiomyomatose).…”

“…Beinlymphödeme nach Behandlung gynäkologischer Tumoren zeigen vergleichbare therapieabhängige Risikofaktoren. Mehrere Autoren geben an, dass hier bereits Übergewicht mit einem BMI über 25 als Komorbidität einen unabhängigen Risikofaktor für die Entstehung eines Lymphödems darstellt [29,40]. Weitere Komorbiditäten wurden nicht dargestellt.…”