School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Gynecol Oncol. 2017 Sep;146(3):623-629. doi: 10.1016/j.ygyno.2017.06.004. Epub 2017 Jun 16.
Cancer-related lymphedema is a debilitating condition that adversely influences function, health and quality of life. The purpose of this study was to assess the prevalence, incidence, and risk factors of lower-limb lymphedema pre- through to 24months post-surgery for gynecological cancer.
A clinic-based sample of women (n=408) with gynecological cancer participated in a prospective, longitudinal study (2008-2011) using self-reported measures (swelling in one or both legs) and objectively measured lymphedema (bioimpedance spectroscopy) at baseline (pre-surgery), six weeks-three months, 6-12months, and 15-24months post-surgery.
At pre-surgery, 15% of women self-reported lymphedema and 27% had measurable evidence of lymphedema. By 24months post-surgery, incidence of new self-reported or measured lymphedema was 45% and 37%, respectively. Three-quarters of these new cases presented by 12-months post-treatment. While lymphedema was transient for some women, 60% had persistent lymphedema. More extensive lymph node dissection, receipt of chemotherapy and radiation therapy, increasing body mass index, insufficient levels of physical activity, diagnosis of vulvar/vaginal cancer and presence of pre-treatment lymphedema were identified as potential risk factors (p<0.05).
Findings support the need for integration of pre-surgical assessment, and prospective, post-treatment surveillance of lymphedema into gynecological cancer care. Future research exploring the role of maintaining healthy body weight, regular physical activity and education about early detection of lymphedema to improve gynecological cancer survivorship is warranted.
癌症相关性淋巴水肿是一种使人虚弱的疾病，会对功能、健康和生活质量产生不利影响。本研究的目的是评估妇科癌症患者手术前至术后 24 个月下肢淋巴水肿的患病率、发病率和危险因素。
本项基于诊所的研究纳入了 408 名患有妇科癌症的女性患者，她们参与了一项前瞻性、纵向研究（2008-2011 年），使用自我报告的测量方法（一条或两条腿肿胀）和客观测量的淋巴水肿（生物阻抗光谱法），分别在基线（手术前）、术后 6 周-3 个月、6-12 个月和 15-24 个月进行评估。
在手术前，15%的女性自我报告患有淋巴水肿，27%的女性存在可测量的淋巴水肿证据。到术后 24 个月时，新出现自我报告或测量的淋巴水肿的发病率分别为 45%和 37%。这些新发病例中有四分之三在治疗后 12 个月内出现。尽管一些女性的淋巴水肿是暂时的，但仍有 60%的女性存在持续性淋巴水肿。更广泛的淋巴结清扫、接受化疗和放疗、体重指数增加、体力活动水平不足、外阴/阴道癌诊断以及存在术前淋巴水肿被确定为潜在的危险因素（p<0.05）。
这些发现支持在妇科癌症护理中整合术前评估和术后淋巴水肿的前瞻性监测。未来的研究需要探索维持健康体重、定期进行身体活动以及教育患者早期发现淋巴水肿，以改善妇科癌症患者的生存质量。
