Lee Su-Jeong, Myong Jun-Pyo, Lee Yun-Hee, Cho Eui-Jin, Lee Sung-Jong, Kim Chan-Joo, Kim Jin-Hwi
Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Department of Occupational & Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
J Clin Med. 2021 Oct 11;10(20):4647. doi: 10.3390/jcm10204647.
Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in patients with endometrial cancer.
We conducted a nationwide, retrospective cohort study of women with endometrial cancer who underwent cancer-direct treatment using the Korean National Health Insurance Service (NHIS) database. Patients were categorized by age, region, income, and treatment modality. Cox proportional hazards regression models were used to analyze the incidence and risk factors of lymphedema. We also analyzed utilization of health care resources for lymphedema using diagnostic and treatment claim codes.
A total of 19,027 patients with endometrial cancer were evaluated between January 2004 and December 2017. Among them, 2493 (13.1%) developed lymphedema. Age (<40 years, adjusted odds ratio [aOR] = 1 vs. 40-59 years, aOR = 1.413; 95% confidence interval (CI) 1.203-1.66 vs. 60+ years, aOR = 1.472; 95% CI 1.239-1.748) and multimodal treatment (surgery only, aOR = 1 vs. surgery + radiation + chemotherapy, aOR = 2.571; 95% CI 2.27-2.912) are considered to be possible risk factors for lymphedema in patients with endometrial cancer ( < 0.001). The utilization of health care resources for the treatment of lymphedema has increased over the years.
Lymphedema is a common complication affecting women with endometrial cancer and leads to an increase in national healthcare costs. Post-treatment surveillance of lymphedema, especially in high-risk groups, is needed.
子宫内膜癌是发达国家最常见的妇科癌症。与治疗相关的淋巴水肿会对患者的生活质量和功能产生负面影响。本研究调查了子宫内膜癌患者淋巴水肿的累积发病率、危险因素以及医疗资源的利用情况。
我们利用韩国国民健康保险服务（NHIS）数据库，对接受癌症直接治疗的子宫内膜癌女性患者进行了一项全国性的回顾性队列研究。患者按年龄、地区、收入和治疗方式进行分类。采用Cox比例风险回归模型分析淋巴水肿的发病率和危险因素。我们还使用诊断和治疗索赔代码分析了淋巴水肿医疗资源的利用情况。
2004年1月至2017年12月期间，共评估了19027例子宫内膜癌患者。其中，2493例（13.1%）发生了淋巴水肿。年龄（<40岁，调整优势比[aOR]=1，对比40 - 59岁，aOR = 1.413；95%置信区间[CI] 1.203 - 1.66，对比60岁及以上，aOR = 1.472；95% CI 1.239 - 1.748）和多模式治疗（仅手术，aOR = 1，对比手术 + 放疗 + 化疗，aOR = 2.571；95% CI 2.27 - 2.912）被认为是子宫内膜癌患者淋巴水肿的可能危险因素（<0.001）。多年来，用于治疗淋巴水肿的医疗资源利用有所增加。
淋巴水肿是影响子宫内膜癌女性患者的常见并发症，并导致国家医疗费用增加。需要对淋巴水肿进行治疗后监测，尤其是在高危人群中。
