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Risk factors for ly...
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Wedin, Madelene,1976-Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, Kvinnokliniken US,Linköping Univ, Biomed & Clin Sci, Linköping, Sweden.
(author)
Risk factors for lymphedema and method of assessment in endometrial cancer: a prospective longitudinal multicenter study
- Article/chapterEnglish2021
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LIBRIS-ID:oai:gup.ub.gu.se/309984
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https://gup.ub.gu.se/publication/309984URI
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https://doi.org/10.1136/ijgc-2021-002890DOI
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https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-190872URI
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https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-180706URI
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-459071URI
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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Funding: Swedish Cancer Society (Cancerfonden)Swedish Cancer Society [CAN2013/620]; Medical Research Council of Southeast SwedenUK Research & Innovation (UKRI)Medical Research Council UK (MRC) [FORSS-308611, FORSS-391311, FORSS-662141, FORSS-858611]; Uppsala-Orebro Regional Research Council [LUL-349271]; Scientific Council of the Region Halland; County Council of Ostergotland; Linkoping University
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Objective The aim of the study was to determine risk factors for lymphedema of the lower limbs, assessed by four methods, 1 year after surgery for endometrial cancer. Methods A prospective longitudinal multicenter study was conducted in 14 Swedish hospitals. 235 women with endometrial cancer were included; 116 underwent surgery including lymphadenectomy, and 119 had surgery without lymphadenectomy. Lymphedema was assessed preoperatively and 1 year postoperatively objectively by systematic circumferential measurements of the legs, enabling volume estimation addressed as (1) crude volume and (2) body mass index-standardized volume, or (3) clinical grading, and (4) subjectively by patient-reported perception of leg swelling. In volume estimation, lymphedema was defined as a volume increase >= 10%. Risk factors were analyzed using forward stepwise logistic regression models and presented as adjusted odds ratio (aOR) and 95% confidence interval (95% CI). Results Risk factors varied substantially, depending on the method of determining lymphedema. Lymphadenectomy was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 14.42, 95% CI 3.49 to 59.62), clinical grading (aOR 2.11, 95% CI 1.04 to 4.29), and patient-perceived swelling (aOR 2.51, 95% CI 1.33 to 4.73), but not when evaluated by crude volume. Adjuvant radiotherapy was only a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 15.02, 95% CI 2.34 to 96.57). Aging was a risk factor for lymphedema when assessed by body mass index-standardized volume (aOR 1.07, 95% CI 1.00 to 1.15) and patient-perceived swelling (aOR 1.06, 95% CI 1.02 to 1.10), but not when assessed by crude volume or clinical grading. Increase in body mass index was a risk factor for lymphedema when estimated by crude volume (aOR 1.92, 95% CI 1.36 to 2.71) and patient-perceived swelling (aOR 1.36, 95% CI 1.11 to 1.66), but not by body mass index-standardized volume or clinical grading. The extent of lymphadenectomy was strongly predictive for the development of lymphedema when assessed by body mass index-standardized volume and patient-perceived swelling, but not by crude volume or clinical grading. Conclusion Apparent risk factors for lymphedema differed considerably depending on the method used to determine lymphedema. This highlights the need for a 'gold standard' method when addressing lymphedema for determining risk factors.
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Stålberg, KarinUppsala universitet,Reproduktiv hälsa(Swepub:uu)kariglim
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Marcickiewicz, J.Department of Obstetrics and Gynecology, Varberg Hospital, Varberg, Sweden,Varberg Hosp, Dept Obstet & Gynecol, Varberg, Sweden.
(author)
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Ahlner, Eva,1953-Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Onkologiska kliniken US,Linköping Univ Hosp, Dept Oncol, Linköping, Sweden.;Linköping Univ Hosp, Dept Biomed & Clin Sci, Linköping, Sweden.(Swepub:liu)evaah73
(author)
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Ottander, UlrikaUmeå universitet,Obstetrik och gynekologi,Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden,Umeå Univ, Dept Clin Sci Obstet & Gynecol, Umeå, Sweden.(Swepub:umu)ulaotr95
(author)
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Åkesson, Åsa,1974Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Institute of clinical sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Inst Clin Sci,Dept Obstet & Gynecol, Gothenburg, Sweden.(Swepub:gu)xjoasa
(author)
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Lindahl, Gabriel,1971-Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Onkologiska kliniken US,Linköping Univ, Dept Oncol, Linköping, Sweden.;Linköping Univ, Dept Biomed & Clin Sci, S-58183 Linköping, Sweden.(Swepub:liu)gabli45
(author)
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Borendal Wodlin, Ninnie,1962-Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, Kvinnokliniken US,Linköping Univ, Dept Biomed & Clin Sci, S-58183 Linköping, Sweden.;Linköping Univ, Dept Obstet & Gynecol Linköping, Linköping, Sweden.(Swepub:liu)ninbo06
(author)
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Kjølhede, Preben,1957-Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, Kvinnokliniken US,Linköping Univ, Dept Biomed & Clin Sci, S-58183 Linköping, Sweden.;Linköping Univ, Dept Obstet & Gynecol Linköping, Linköping, Sweden.(Swepub:liu)prekj14
(author)
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Linköpings universitetAvdelningen för barns och kvinnors hälsa
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In:International Journal of Gynecological Cancer: BMJ31:11, s. 1416-14271048-891X1525-1438
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