Risk Factors For Treated Gynaecological Cancer-related Lower Extremity Lymphedema: A Meta-analysis

Objective: In recent years,many researchs have examined the factors for lower extremity lymphedema after gynecological cancer treatment,but the conclusions are not unified,some are even conficting each other.This meta-analysis was used to analyze the risk factors of lower extremity lymphedema in treated-patients with commom gynecological cancer,which then guides clinical work.Methods: PubMed,EMbase and the Cochrane Library were searched to identify clinical trials published up to August 2016,and their references were retrieved in order to obtain additional information.Search terms include ”ovary cancer”;“cervical cancer “;”endometrial cancer”;”lower limb”;”lymphedema”;”risk factors”and so on.The quality of included studies was assessed by the Newcastle-Ottawa Scale;Establish a database and do initial operation data by excel 2007,and analysis was performed by Stata 14.0 and RevMan 5.3;the strength of associations between risk factors and gynaecological cancer-related lower extremity lymphedema was described as odds ratio(OR)and 95%confidence intervals(CI).The literature only containing OR value and 95% CI indirectly was calculating by using H-M method;the literature containing OR value and 95% CI directly was calculating by using IV method.Heterogeneity test was evaluated by Q statistical test and I-squared tset.When there were statistically homogeneity among the study results(P> 0.1,I2 ?50%),data was analyzed using a fixed effects model;while significant heterogeneity(P <0.1,I2> 50%),then data was analyzed using a random effects model.Sensitivity analysis was evaluated by eliminating a single study.If the consolidated result is not sensitive toit,the study is very stable statistically.Publication bias using Egger's linear regression analysis,P<0.05 was considered statistically significant.Results: Eighteen studies were included in the meta-analysis.The quality of included studies were evaluated by the Newcastle Ottawa scale(Newcastle Ottawa Scale,NOS)evaluation criteria.There were 18 documents,which 9 were rated as Class A,9 as Class B,so they were high quality studies.By combining analysis of risk factors including FIGO stage and radiotherapy using the fixed effects mode,and risk factors including body mass index,age,operative technique,chemotherapy,paraortic and pelvis lymph node dissection.using the random effects mode,the results showed the risk factors for lower extremity lymphedema after gynaecological cancer treatment mainly included radiotherapy(OR=2.45,95%CI=2.05-2.94,P<0.001),FIGO stage(OR=2.29,95%CI=1.66-3.14,P<0.001),and pelvis lymph node dissection(OR=2.00,95%CI=1.02-3.91,P=0.04),while no significant associations were found for such factors as body mass index,age,operative technique,chemotherapy and paraortic lymph node dissection.Conclusions: This article included in the literature reported the incidence of treated-related lower extremity lymphedema varied from 2.9% to 59.0%.Radiotherapy,FIGO stage,and pelvis lymph node dissection are the main risk factors for lower extremity lymphedema after gynaecological cancer treatment by evaluation and analysis system.