Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
Acta Oncol. 2023 Oct;62(10):1279-1285. doi: 10.1080/0284186X.2023.2251669. Epub 2023 Aug 30.
Secondary lymphedema is a known side effect to radiotherapy (RT), but limited information regarding prevalence and risk factors for lower limb edema (LLE) after curative radiotherapy in patients with prostate cancer (PCa) is available. This study provides a descriptive analysis of patient-reported LLE with analysis of risk factors in a cohort of patients with PCa treated with curative RT.
A total of 302 patients with PCa with prospective registration of patient-reported LLE (EORTC QLQ-PR25 (Question 46)) were included. Analysis of LLE was done with the calculation of prevalence rates and Kaplan-Meier statistics. Risk factors for LLE were analyzed multivariate with Cox regression analysis.
At a median follow-up of 15 (3-51) months, the overall crude incidence of patients reporting 'quite a bit' or 'a lot' of LLE was 49 (16.2%) and 21 (7.0%), respectively. The baseline prevalence rate of 'quite a bit' and 'a lot' of LLE was 5.0% and 0.8%, respectively. During follow-up the prevalence rate for 'quite a bit' or 'a lot' of LLE increased significantly and remained constant from 6 months where 11.5% (±1.7%) reported 'quite a bit' and 2.9% (±0.5%) reported 'very much' LLE ( < 0.001), respectively.Significant risk factors ( < 0.10) for LLE in univariate analysis included lymph node irradiation (HR:2.325), baseline Body Mass Index (BMI) (HR:1.100), Charlson Comorbidity Index (HR:1.227), Androgen Deprivation Therapy (HR:2,979), and Performance Status (HR:0.594). Only high BMI (HR:1.091) remained significant in multivariate analysis with a three-fold increase in LLE in patients with BMI ≥ 30 compared to normal weight patients.
Severe patient-reported LLE after curative RT for PCa is rare. Significantly more patients with a high BMI report 'quite a bit' or 'very much' LLE compared to patients with a normal BMI. Obese PCa patients could be offered a rehabilitation program for early detection and management of LLE.
继发性淋巴水肿是放疗（RT）的已知副作用，但关于前列腺癌（PCa）患者根治性放疗后下肢水肿（LLE）的患病率和危险因素的信息有限。本研究对接受根治性放疗的 PCa 患者队列中患者报告的 LLE 进行描述性分析，并分析了危险因素。
共纳入 302 例接受前瞻性 LLE 患者报告（EORTC QLQ-PR25（问题 46））的 PCa 患者。采用患病率计算和 Kaplan-Meier 统计分析 LLE。采用 Cox 回归分析对 LLE 的危险因素进行多变量分析。
中位随访 15（3-51）个月，报告“相当多”或“很多”LLE 的患者总体粗发生率分别为 49（16.2%）和 21（7.0%）。“相当多”和“很多”LLE 的基线患病率分别为 5.0%和 0.8%。随访期间，“相当多”或“很多”LLE 的患病率显著增加，并在 6 个月时保持稳定，分别有 11.5%（±1.7%）报告“相当多”和 2.9%（±0.5%）报告“非常多”LLE（ < 0.001）。单因素分析中 LLE 的显著危险因素（ < 0.10）包括淋巴结照射（HR：2.325）、基线体重指数（BMI）（HR：1.100）、Charlson 合并症指数（HR：1.227）、雄激素剥夺治疗（HR：2.979）和体能状态（HR：0.594）。多因素分析中仅高 BMI（HR：1.091）仍有意义，与体重正常患者相比，BMI≥30 的患者 LLE 增加三倍。
根治性放疗后 PCa 患者严重的患者报告 LLE 罕见。与 BMI 正常的患者相比，BMI 较高的患者报告“相当多”或“非常多”LLE 的患者明显更多。肥胖的 PCa 患者可以提供康复计划，以便早期发现和管理 LLE。
