| Background of the study:Lymph node dissection is an important component of surgical treatment for gynecologic malignancies,but lymph node dissection may increase the risk of postoperative complications such as neurovascular injury,celiac disease,postoperative lymphoid cyst,lower extremity lymphedema,and lower extremity deep vein thrombosis.Among them,lower limb lymphedema is a common long-term complication,with its incidence reported in foreign literature as 2.3%-47.6% and in domestic literature as about 20%,which may be related to different diagnostic criteria and postoperative follow-up time.Lower extremity lymphedema can occur immediately after surgery or years after treatment,but most patients develop it within 1 year after surgery.Once it occurs,it is often lifelong and difficult to be cured.If lymphedema continues to progress,it may even cause disability in the lower limbs,causing serious physical and psychological burden to patients.At present,there are more studies on lymphedema of the upper extremity after breast cancer surgery,but fewer studies on lymphedema of the lower extremity after gynecologic malignancy surgery,and the results of studies on related risk factors vary greatly,and most of the data are foreign studies.At present,there is no recognized treatment for complete reversal of lower limb lymphedema at home and abroad,and there is a lack of targeted prevention strategies,mostly based on empirical care prevention,so early identification of risk factors for lower limb lymphedema is especially important.Purpose of the study:In this study,we retrospectively analyzed the clinical data of patients with gynecologic malignancies who developed lower limb lymphedema,screened out risk factors,and constructed a risk prediction model to give key attention and education to high-risk patients who might develop lymphedema after surgery,to detect the corresponding symptoms early,to achieve early prevention and intervention,to reduce the risk of lower limb lymphedema,and to slow down the progression of lower limb lymphedema.Study methods:In this study,based on the fact that the included gynecologic malignancies had consistent lymph node dissection ranges,a retrospective analysis was used to collect 261 patients who attended the Department of Gynecology,First Affiliated Hospital of Henan University for pelvic lymph node dissection ± para-aortic lymph node dissection for gynecologic malignancies from January 2018 to December 2021.All patients were followed up electronically or by telephone,including 3 deaths and 12 missed visits,and a total of 246 patients were finally included in the study.The patients were divided into lower limb lymphedema group and nonlower limb lymphedema group according to whether lower limb lymphedema occurred after surgery,including 49 cases in the lower limb lymphedema group and 197 cases in the non-lower limb lymphedema group.The general data(age,body mass index BMI,history of hypertension,history of diabetes),tumorrelated indexes(tumor diameter,stage,degree of differentiation,presence of lymph node metastasis),surgery and postoperative-related indexes(extent and number of lymph nodes removed,chemotherapy,radiotherapy,postoperative drainage time,presence of lymphatic cysts,presence of postoperative incision infection or delayed healing)were collected from all patients.The SPSS21.0 software was used to perform univariate analysis on the clinical data of the two groups to determine the factors associated with the occurrence of lower limb lymphedema,and the independent risk factors for the occurrence of postoperative lower limb lymphedema were screened out by multi-factor regression analysis,and a prediction model was established on this basis.RStudio software was applied to draw the column line graph model for predicting lower limb lymphedema,and the consistency index C-index(i.e.,AUC)was used to evaluate the discrimination of the model.Bootstrap resampling method was used for internal validation,and curves were plotted to evaluate the calibration degree of the model.Finally,the clinical application value of the model was evaluated by clinical decision curve(DCA).Results:1.A total of 246 patients with postoperative gynecologic malignancies were included in this study,and they were divided into LLL group(n=49)and non-LLL group(n=197)according to whether lower limb lymphedema occurred after surgery,with an overall incidence of 19.9%(49/246).The incidence of postoperative lymphedema in each type of tumor was 22.7%(20/88)for cervical cancer,19.6%(19/97)for endometrial cancer,and 16.4%(10/61)for ovarian cancer,respectively,and there was no statistically significant difference in the incidence of postoperative lower limb lymphedema in different types of tumors(P=0.632).2.Univariate analysis showed significant differences between the two groups in age,BMI,hypertension,number of lymph nodes resected,chemotherapy,and radiotherapy(P < 0.05),while there was no significant correlation in diabetes mellitus,extent of lymph node resection,tumor stage and differentiation,tumor diameter,postoperative lymphatic cysts,postoperative drainage time,incisional infection or delayed healing,and lymph node metastasis(P > 0.05).3.The results of multifactorial regression analysis showed that age,BMI,hypertension,number of lymph nodes resected,and radiotherapy were independent risk factors for the development of lower limb lymphedema in patients with gynecologic malignancies after surgery.4.According to the drawn column line diagram,the score corresponding to each predictor was determined on the score line(Point)and the total score was calculated.The value of the risk line(Risk)corresponding to the total score line(Total Points)was the probability of lower limb lymphedema in patients with gynecologic malignancies.5.The sensitivity of the risk prediction model for postoperative lower limb lymphedema in gynecologic malignancies was 81.6%,the specificity was 79.2%,and the AUC was 0.884,lying between 0.7 and 0.9,indicating that the model was well differentiated.The mean error of the calibration curve was 0.028,indicating that the model was well calibrated.Both calibration curves in the clinical decision curve were close to the ideal curve,indicating that the model has some clinical application value.Conclusions:1,Age,BMI,hypertension,number of lymph nodes removed,and radiotherapy are independent risk factors for the occurrence of lower limb lymphedema after surgery in patients with gynecologic malignancies.2.The prediction model for postoperative lower limb lymphedema in gynecologic malignancies constructed in this study has good predictive power,calibration ability. |
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