Risk factors for lower extremity lymphedema after surgery in cervical and endometrial cancer|RISS 상세보기

다국어 초록 (Multilingual Abstract)

Objective: Lower extremity lymphedema (LEL) is a well-known adverse effect related to cervical and endometrial cancer (CEC); however, very few studies have elucidated the clinicopathologic risk factors related to LEL. We investigated the incidence and risk factors in patients who received primary surgery and/or adjuvant radiotherapy (RT) or chemotherapy for CEC.
Methods: We retrospectively reviewed 2,565 patients who underwent primary surgery following CEC diagnosis between January 2007 and December 2020. LEL diagnosis was based on objective and subjective assessments by experts. We identified important predictors of LEL to construct a nomogram predicting individual risks of LEL. For internal validation of the nomogram, the original data were separated using the split-sample method in a 7:3 ratio of training data and test data.
Results: Overall, 858 patients (33.5%) received RT, 586 received external beam RT (EBRT), and 630 received intracavitary RT. During follow-up period, LEL developed in 331 patients, with an overall cumulative 5-year incidence of 13.3%. In multivariate analysis, age at primary treatment, use of docetaxel-based chemotherapy, type of hysterectomy, type of surgical pelvic lymph node (LN) assessment, number of dissected pelvic and para-aortic LNs, and EBRT field were the independent predictors of LEL. We subsequently developed the nomogram showing excellent predictive power for LEL.
Conclusion: LEL is associated with various treatment modalities, and their interactions may increase the possibility of occurrences. De-escalation strategies for treatment modalities should be considered to reduce LEL in patients with CEC.

번역하기

참고문헌 (Reference)

1 Guastalla JP 3rd, "The taxanes : toxicity and quality of life considerations in advanced ovarian cancer" 89 (89): S16-S22, 2003

2 Devarati Mitra ; Paul J. Catalano ; Nicole Cimbak ; Antonio L. Damato ; Michael G. Muto ; Akila N. Viswanathan, "The risk of lymphedema after postoperative radiation therapy in endometrial cancer" 대한부인종양학회 27 (27): 1-11, 2016

3 International Society of Lymphology, "The diagnosis and treatment of peripheral lymphedema : 2013 Consensus Document of the International Society of Lymphology" 46 : 1-11, 2013

4 Jung SG, "The association between the number of retrieved pelvic lymph nodes and ipsilateral lower limb lymphedema in patients with gynecologic cancer" 35 : 978-983, 2022

5 Byun HK, "Risk of lymphedema following contemporary treatment for breast cancer : an analysis of 7617 consecutive patients from a multidisciplinary perspective" 274 : 170-178, 2021

6 Todo Y, "Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy" 119 : 60-64, 2010

7 Kunitake T, "Risk factors for lower limb lymphedema in gynecologic cancer patients after initial treatment" 25 : 963-971, 2020

8 Klopp AH, "Patient-reported toxicity during pelvic intensity-modulated radiation therapy : NRG Oncology-RTOG 1203" 36 : 2538-2544, 2018

9 Frumovitz M, "Near-infrared fluorescence for detection of sentinel lymph nodes in women with cervical and uterine cancers(FILM) : a randomised, phase 3, multicentre, non-inferiority trial" 19 : 1394-1403, 2018

10 Yost KJ, "Lymphedema after surgery for endometrial cancer : prevalence, risk factors, and quality of life" 124 : 307-315, 2014