Yoo Baraem, Ahn Hyojeong, Kim Miseon, Suh Dong Hoon, Kim Kidong, No Jae Hong, Kim Yong Beom
Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
Obstet Gynecol Sci. 2017 Sep;60(5):440-448. doi: 10.5468/ogs.2017.60.5.440. Epub 2017 Sep 18.
The purpose of this study is to estimate the risk of postoperative lymphocele development after lymphadenectomy in gynecologic cancer patients through establishing a nomogram.
We retrospectively reviewed 371 consecutive gynecologic cancer patients undergoing lymphadenectomy between 2009 and 2014. Association of the development of postoperative lymphocele with clinical characteristics was evaluated in univariate and multivariate regression analyses. Nomograms were built based on the data of multivariate analysis using R-software.
Mean age at the operation was 50.8±11.1 years. Postoperative lymphocele was found in 70 (18.9%) patients. Of them, 22 (31.4%) had complicated one. Multivariate analysis revealed that hypertension (hazard ratio [HR], 3.0; 95% confidence interval [CI], 1.5 to 6.0; =0.003), open surgery (HR, 3.2; 95% CI, 1.4 to 7.1; =0.004), retrieved lymph nodes (LNs) >21 (HR, 1.8; 95% CI, 1.0 to 3.3; =0.042), and no use of intermittent pneumatic compression (HR, 2.7; 95% CI, 1.0 to 7.2; =0.047) were independent risk factors for the development of postoperative lymphocele. The nomogram appeared to be accurate and predicted the lymphocele development better than chance (concordance index, 0.754). For complicated lymphoceles, most variables which have shown significant association with general lymphocele lost the statistical significance, except hypertension (=0.011) and mean number of retrieved LNs (29.5 vs. 21.1; =0.001). A nomogram for complicated lymphocele showed similar predictive accuracy (concordance index, 0.727).
We developed a nomogram to predict the risk of lymphocele in gynecologic cancer patients on the basis of readily obtained clinical variables. External validation of this nomogram in different group of patients is needed.
本研究旨在通过建立列线图来评估妇科癌症患者淋巴结清扫术后发生淋巴囊肿的风险。
我们回顾性分析了2009年至2014年间连续接受淋巴结清扫术的371例妇科癌症患者。在单因素和多因素回归分析中评估术后淋巴囊肿的发生与临床特征之间的关联。使用R软件基于多因素分析的数据构建列线图。
手术时的平均年龄为50.8±11.1岁。70例（18.9%）患者发现术后淋巴囊肿。其中，22例（31.4%）出现复杂性淋巴囊肿。多因素分析显示，高血压（风险比[HR]，3.0；95%置信区间[CI]，1.5至6.0；P=0.003）、开放手术（HR，3.2；95%CI，1.4至7.1；P=0.004）、切除淋巴结（LNs）>21枚（HR，1.8；95%CI，1.0至3.3；P=0.042）以及未使用间歇性气动压迫（HR，2.7；95%CI，1.0至7.2；P=0.047）是术后淋巴囊肿发生的独立危险因素。该列线图似乎准确，且对淋巴囊肿发生的预测优于随机概率（一致性指数，0.754）。对于复杂性淋巴囊肿，除高血压（P=0.011）和切除LNs的平均数量（29.5对21.1；P=0.001）外，大多数与一般淋巴囊肿有显著关联的变量失去了统计学意义。复杂性淋巴囊肿的列线图显示出相似的预测准确性（一致性指数，0.727）。
我们基于易于获得的临床变量开发了一种列线图，以预测妇科癌症患者发生淋巴囊肿的风险。需要在不同患者群体中对该列线图进行外部验证。
