Masato Yoshihara1, Ryoko Shimono2, Satoko Tsuru3, Kaoru Kitamura4, Hiromi Sakuda5, Hidenori Oguchi6, Akio Hirota7. 1. Nagoya University Graduate School of Medicine, Department of Obstetrics and Gynecology, 65 Tsurumai-cho, Showa-ku, Nagoya-city Aichi, 466-8550, Japan. 2. The University of Tokyo, Organization for Interdisciplinary Research Project, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan. 3. The University of Tokyo, School of Engineering, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan. Electronic address: tsuru@tqm.t.u-tokyo.ac.jp. 4. Kaizuka Hospital, Department of Breast Surgery, 7-7-27 Hakozaki Higashi-ku, Fukuoka-city, Fukuoka, 812-0053, Japan. 5. Osaka City University Graduate School of Nursing, School of Nursing, 1-5-17 Asahi-machi, Abeno-ku, Osaka-city, Osaka, 545-0051, Japan. 6. TOYOTA Memorial Hospital, Department of Obstetrics and Gynecology, 1-1 Heiwa-cho, Toyota-city, Aichi, 471-8513, Japan. 7. Hirota Internal Medicine Clinic, 5-19-10 Minamikarasuyama, Setagaya-ku, Tokyo, 157-0062, Japan.
Abstract
INTRODUCTION: Late-onset lower limb lymphedema (LLL) is a significant clinical challenge for physicians dealing with patients that undergo treatment involving the pelvic cavity. We aimed to clarify the prevalence of and risk factors for late-onset LLL after treatment for gynecological cancer. METHODS: We conducted a multicenter retrospective study using records of cases in which LLL diagnosed by physical findings and measurement of limbs girths. Patients with LLL after treatment for uterine cervical, endometrial, and ovarian cancer were sequentially enrolled. We examined the timing of LLL onset and the associations between the time to onset and clinical characteristics, including age, type of cancer, lymphadenectomy sites, and performance of radiotherapy. We also investigated the risk factors for late-onset LLL and their effects on the cumulative incidence of late-onset LLL. RESULTS: In total, 711 patients fulfilled the required criteria. Mean age of was 50.2 years old and median follow-up period was 5.05 years. More than half of them (50.5%) presented with LLL ≥5 years after undergoing treatment for gynecological cancer. A substantial number of patients (29.4%) developed LLL ≥10 years after undergoing treatment for gynecological cancer. Being aged <50 years [(odds ratio (OR): 1.919, P = 0.001), cervical cancer (OR: 1.912, P = 0.001), and radiotherapy (OR: 1.664, P = 0.017) were identified as significant risk factors for late-onset LLL in multivariate logistic regression analysis. CONCLUSIONS: A substantial number of patients present with LLL ≥5 years after receiving treatment for gynecological malignancies. Clinicians are required to identify high-risk patients and inform them of the risk of late-onset LLL.
INTRODUCTION: Late-onset lower limb lymphedema (LLL) is a significant clinical challenge for physicians dealing with patients that undergo treatment involving the pelvic cavity. We aimed to clarify the prevalence of and risk factors for late-onset LLL after treatment for gynecological cancer. METHODS: We conducted a multicenter retrospective study using records of cases in which LLL diagnosed by physical findings and measurement of limbs girths. Patients with LLL after treatment for uterine cervical, endometrial, and ovarian cancer were sequentially enrolled. We examined the timing of LLL onset and the associations between the time to onset and clinical characteristics, including age, type of cancer, lymphadenectomy sites, and performance of radiotherapy. We also investigated the risk factors for late-onset LLL and their effects on the cumulative incidence of late-onset LLL. RESULTS: In total, 711 patients fulfilled the required criteria. Mean age of was 50.2 years old and median follow-up period was 5.05 years. More than half of them (50.5%) presented with LLL ≥5 years after undergoing treatment for gynecological cancer. A substantial number of patients (29.4%) developed LLL ≥10 years after undergoing treatment for gynecological cancer. Being aged <50 years [(odds ratio (OR): 1.919, P = 0.001), cervical cancer (OR: 1.912, P = 0.001), and radiotherapy (OR: 1.664, P = 0.017) were identified as significant risk factors for late-onset LLL in multivariate logistic regression analysis. CONCLUSIONS: A substantial number of patients present with LLL ≥5 years after receiving treatment for gynecological malignancies. Clinicians are required to identify high-risk patients and inform them of the risk of late-onset LLL.
Authors: Linda Åkeflo; Gail Dunberger; Eva Elmerstig; Viktor Skokic; Gunnar Steineck; Karin Bergmark Journal: BMJ Open Date: 2021-07-21 Impact factor: 2.692