Decorte Tina, Cerckel Marie, Kheir George Bou, Monten Chris, Vandecasteele Katrien, Vanden Bossche Luc, Pauwels Nele S, Randon Caren
Department of Physical Medicine and Rehabilitation and Clinic for Lymphatic Disorders, Ghent University Hospital, Ghent, Belgium.
Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Front Oncol. 2025 May 20;15:1561836. doi: 10.3389/fonc.2025.1561836. eCollection 2025.
As treatments in gynecological cancer improve, the number of cancer survivors increases, with more patients facing long-term side effects of their treatment. One debilitating side effect is lower limb lymphedema (LLL). Unlike upper limb lymphedema (ULL), diagnosis of LLL remains challenging due to the absence of a clear definition, bilateral presentation complicating comparison, and confusion with post-operative weight changes. This systematic review investigated incidences and risk factors for LLL.
We systematically searched PubMed, Embase, and CENTRAL databases for articles on LLL following treatment for pelvic gynecological cancer from 1979 to November 2024. Two independent researchers extracted data, based on predefined inclusion and exclusion criteria. We assessed bias using the Risk of Bias in Non-Randomized Studies (ROBINS-I) tool and adhered to PRISMA reporting guidelines.
Our review included 46 studies, with incidence rates varying widely across cancer types: 7.4-55.9% in cervical cancer, 1.2-47% in endometrial cancer, 5.6-30.4% in ovarian cancer, and 10.1-43% in vulvar cancer. Several risk factors for LLL emerged. Notably, lymphadenectomy, the number of removed lymph nodes, radiotherapy, and a body mass index (BMI) exceeding 25 kg/m² were significant risk factors. Surgical technique did not impact LLL risk.
LLL frequently occurs following gynecological cancer treatments, emphasizing the importance of careful monitoring and proactive management in clinical settings. Overall, the findings highlight the complexity and variability in risk factors for LLL across different gynecological cancers. The significant heterogeneity in study designs, populations, and methodologies underscores the need for standardized approaches in future research to better understand and mitigate the risk of LLL in these patients.
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42020198642.
随着妇科癌症治疗方法的改进，癌症幸存者的数量不断增加，越来越多的患者面临治疗的长期副作用。一种使人衰弱的副作用是下肢淋巴水肿（LLL）。与上肢淋巴水肿（ULL）不同，由于缺乏明确的定义、双侧表现使比较复杂化以及与术后体重变化相混淆，LLL的诊断仍然具有挑战性。本系统评价调查了LLL的发病率和危险因素。
我们系统检索了PubMed、Embase和CENTRAL数据库，以查找1979年至2024年11月期间盆腔妇科癌症治疗后有关LLL的文章。两名独立研究人员根据预先确定的纳入和排除标准提取数据。我们使用非随机研究中的偏倚风险（ROBINS-I）工具评估偏倚，并遵循PRISMA报告指南。
我们的评价纳入了46项研究，不同癌症类型的发病率差异很大：宫颈癌为7.4%-55.9%，子宫内膜癌为1.2%-47%，卵巢癌为5.6%-30.4%，外阴癌为10.1%-43%。出现了几个LLL的危险因素。值得注意的是，淋巴结清扫术、切除淋巴结的数量、放疗以及体重指数（BMI）超过25kg/m²是显著的危险因素。手术技术不影响LLL风险。
LLL在妇科癌症治疗后经常发生，强调了在临床环境中仔细监测和积极管理的重要性。总体而言，研究结果突出了不同妇科癌症中LLL危险因素的复杂性和变异性。研究设计、人群和方法的显著异质性强调了未来研究需要采用标准化方法，以更好地理解和降低这些患者发生LLL的风险。
