Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study
Identifieur interne : 000209 ( Main/Exploration ); précédent : 000208; suivant : 000210Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study
Auteurs : Kenji Kuroda [Japon] ; Yasuhiro Yamamoto [Japon] ; Manami Yanagisawa [Japon] ; Akira Kawata [Japon] ; Naoya Akiba [Japon] ; Kensuke Suzuki [Japon] ; Kazutoshi Naritaka [Japon]Source :
- BMC Women's Health [ 1472-6874 ] ; 2017.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Aire sous la courbe, Complications postopératoires (étiologie), Estimation de Kaplan-Meier, Facteurs de risque, Femelle, Humains, Hôpitaux (), Incidence, Lymphadénectomie (), Lymphadénectomie (effets indésirables), Lymphoedème (anatomopathologie), Lymphoedème (épidémiologie), Lymphoedème (étiologie), Membre inférieur (anatomopathologie), Modèles de hasards proportionnels, Modèles théoriques, Noeuds lymphatiques (anatomopathologie), Prévalence, Sujet âgé, Tumeurs de l'appareil génital féminin (), Tumeurs de l'appareil génital féminin (anatomopathologie), Études rétrospectives, Évaluation des risques ().
- MESH :
- anatomopathologie : Lymphoedème, Membre inférieur, Noeuds lymphatiques, Tumeurs de l'appareil génital féminin.
- effets indésirables : Lymphadénectomie.
- épidémiologie : Lymphoedème.
- étiologie : Complications postopératoires, Lymphoedème.
- Adulte, Adulte d'âge moyen, Aire sous la courbe, Estimation de Kaplan-Meier, Facteurs de risque, Femelle, Humains, Hôpitaux, Incidence, Lymphadénectomie, Modèles de hasards proportionnels, Modèles théoriques, Prévalence, Sujet âgé, Tumeurs de l'appareil génital féminin, Études rétrospectives, Évaluation des risques.
English descriptors
- KwdEn :
- Adult, Aged, Area Under Curve, Female, Genital Neoplasms, Female (pathology), Genital Neoplasms, Female (surgery), Hospitals (statistics & numerical data), Humans, Incidence, Kaplan-Meier Estimate, Lower Extremity (pathology), Lymph Node Excision (adverse effects), Lymph Node Excision (methods), Lymph Nodes (pathology), Lymphedema (epidemiology), Lymphedema (etiology), Lymphedema (pathology), Middle Aged, Models, Theoretical, Postoperative Complications (etiology), Prevalence, Proportional Hazards Models, Retrospective Studies, Risk Assessment (methods), Risk Factors.
- MESH :
- adverse effects : Lymph Node Excision.
- epidemiology : Lymphedema.
- etiology : Lymphedema, Postoperative Complications.
- methods : Lymph Node Excision, Risk Assessment.
- pathology : Genital Neoplasms, Female, Lower Extremity, Lymph Nodes, Lymphedema.
- statistics & numerical data : Hospitals.
- surgery : Genital Neoplasms, Female.
- Adult, Aged, Area Under Curve, Female, Humans, Incidence, Kaplan-Meier Estimate, Middle Aged, Models, Theoretical, Prevalence, Proportional Hazards Models, Retrospective Studies, Risk Factors.
Abstract
Lower 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.
Pelvic 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.
The 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.
BMI ≥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.
Url:
DOI: 10.1186/s12905-017-0403-1
PubMed: 28743274
PubMed Central: 5526302
Affiliations:
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Le document en format XML
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<term>Aged</term>
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<term>Genital Neoplasms, Female (surgery)</term>
<term>Hospitals (statistics & numerical data)</term>
<term>Humans</term>
<term>Incidence</term>
<term>Kaplan-Meier Estimate</term>
<term>Lower Extremity (pathology)</term>
<term>Lymph Node Excision (adverse effects)</term>
<term>Lymph Node Excision (methods)</term>
<term>Lymph Nodes (pathology)</term>
<term>Lymphedema (epidemiology)</term>
<term>Lymphedema (etiology)</term>
<term>Lymphedema (pathology)</term>
<term>Middle Aged</term>
<term>Models, Theoretical</term>
<term>Postoperative Complications (etiology)</term>
<term>Prevalence</term>
<term>Proportional Hazards Models</term>
<term>Retrospective Studies</term>
<term>Risk Assessment (methods)</term>
<term>Risk Factors</term>
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<term>Adulte d'âge moyen</term>
<term>Aire sous la courbe</term>
<term>Complications postopératoires (étiologie)</term>
<term>Estimation de Kaplan-Meier</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Hôpitaux ()</term>
<term>Incidence</term>
<term>Lymphadénectomie ()</term>
<term>Lymphadénectomie (effets indésirables)</term>
<term>Lymphoedème (anatomopathologie)</term>
<term>Lymphoedème (épidémiologie)</term>
<term>Lymphoedème (étiologie)</term>
<term>Membre inférieur (anatomopathologie)</term>
<term>Modèles de hasards proportionnels</term>
<term>Modèles théoriques</term>
<term>Noeuds lymphatiques (anatomopathologie)</term>
<term>Prévalence</term>
<term>Sujet âgé</term>
<term>Tumeurs de l'appareil génital féminin ()</term>
<term>Tumeurs de l'appareil génital féminin (anatomopathologie)</term>
<term>Études rétrospectives</term>
<term>Évaluation des risques ()</term>
</keywords>
<keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Lymph Node Excision</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Lymphoedème</term>
<term>Membre inférieur</term>
<term>Noeuds lymphatiques</term>
<term>Tumeurs de l'appareil génital féminin</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Lymphadénectomie</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term>
<term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Lymph Node Excision</term>
<term>Risk Assessment</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Genital Neoplasms, Female</term>
<term>Lower Extremity</term>
<term>Lymph Nodes</term>
<term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Hospitals</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Genital Neoplasms, Female</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Lymphoedème</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Complications postopératoires</term>
<term>Lymphoedème</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Area Under Curve</term>
<term>Female</term>
<term>Humans</term>
<term>Incidence</term>
<term>Kaplan-Meier Estimate</term>
<term>Middle Aged</term>
<term>Models, Theoretical</term>
<term>Prevalence</term>
<term>Proportional Hazards Models</term>
<term>Retrospective Studies</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Aire sous la courbe</term>
<term>Estimation de Kaplan-Meier</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Hôpitaux</term>
<term>Incidence</term>
<term>Lymphadénectomie</term>
<term>Modèles de hasards proportionnels</term>
<term>Modèles théoriques</term>
<term>Prévalence</term>
<term>Sujet âgé</term>
<term>Tumeurs de l'appareil génital féminin</term>
<term>Études rétrospectives</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p id="Par1">Lower 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.</p>
</sec>
<sec><title>Methods</title>
<p id="Par2">Pelvic 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.</p>
</sec>
<sec><title>Results</title>
<p id="Par3">The 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/m<sup>2</sup>
(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.</p>
</sec>
<sec><title>Conclusion</title>
<p id="Par4">BMI ≥25 kg/m<sup>2</sup>
, 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.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ferlay, J" uniqKey="Ferlay J">J Ferlay</name>
</author>
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<author><name sortKey="Tan, Bk" uniqKey="Tan B">BK Tan</name>
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<author><name sortKey="Steineck, G" uniqKey="Steineck G">G Steineck</name>
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<author><name sortKey="Lee, Kh" uniqKey="Lee K">KH Lee</name>
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</analytic>
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</TEI>
<affiliations><list><country><li>Japon</li>
</country>
</list>
<tree><country name="Japon"><noRegion><name sortKey="Kuroda, Kenji" sort="Kuroda, Kenji" uniqKey="Kuroda K" first="Kenji" last="Kuroda">Kenji Kuroda</name>
</noRegion>
<name sortKey="Akiba, Naoya" sort="Akiba, Naoya" uniqKey="Akiba N" first="Naoya" last="Akiba">Naoya Akiba</name>
<name sortKey="Kawata, Akira" sort="Kawata, Akira" uniqKey="Kawata A" first="Akira" last="Kawata">Akira Kawata</name>
<name sortKey="Naritaka, Kazutoshi" sort="Naritaka, Kazutoshi" uniqKey="Naritaka K" first="Kazutoshi" last="Naritaka">Kazutoshi Naritaka</name>
<name sortKey="Suzuki, Kensuke" sort="Suzuki, Kensuke" uniqKey="Suzuki K" first="Kensuke" last="Suzuki">Kensuke Suzuki</name>
<name sortKey="Yamamoto, Yasuhiro" sort="Yamamoto, Yasuhiro" uniqKey="Yamamoto Y" first="Yasuhiro" last="Yamamoto">Yasuhiro Yamamoto</name>
<name sortKey="Yanagisawa, Manami" sort="Yanagisawa, Manami" uniqKey="Yanagisawa M" first="Manami" last="Yanagisawa">Manami Yanagisawa</name>
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</tree>
</affiliations>
</record>
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