부인암 관련 하지 림프부종의 유병률 및 위험인자
The prevalence and risk factors of lower limb lymphedema in the patients with gynecologic neoplasms
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목적: 한국에서 부인과 관련 암 치료를 받은 환자에서 하지부종의 유병률과 위험 인자의 확인하기 위하여 시행되었다. 연구 방법: 2003년 1월부터 2006년 12월까지 4년 동안 수술적 치료 및 비수술적 치료를 받은 242명의 부인과 암 환자의 의무기록과 면담을 후향적으로 분석하였다. 의무기록 혹은 면담에 의한 기록을 통해 하지부종이 있는 환자를 확인하였고, 그 후 통계학적인 특징, 다른 의학적 병력, 암의 유형과 병기, 림프절의 절제, 수술방법, 항암치료, 방사선치료, 호르몬치료와 혈액검사 결과를 확인하였다. 그리고 이 결과로부터 다중 다변량 회귀분석을 통하여 하지의 림프부종에 대한 위험 요인을 평가하였다. 결과: 242명의 환자 중 48명 (19.8%)에서 하지 림프부종이 있었다. 하지부종이 있는 환자들은 체질량 지수가 더 높았고, 방사선 치료, 항암 치료의 병력이 있었으며, 림프절절제와 근치적 자궁절제술을 받았던 경우가 많았다. 다변량 분석을 통해 체질량 지수, 방사선 치료 병력과 림프절절제는 부인과 암치료 후 하지부종에 대한 독립적 위험 인자임을 보였다. 결론: 방사선 치료를 받았거나, 체질량 지수가 25 이상인 경우 그리고 림프절 절제를 시행한 환자는 부인과 암치료 후 하지부종이 발생할 가능성이 있다. 그래서 이들 환자들은 추적관찰 기간 동안 질병의 발생률과 예방법과 치료에 대하여 교육을 받아야 한다.
Abstract
Objective: To identify the prevalence and risk factors for lower limb lymphedema in the patients after gynecologic neoplasms treatment in Korea. Methods: We retrospectively reviewed the medical records and interviewed 242 gynecologic neoplasms patients who have managed surgically and medically over a 4 year period between January 2003 and December 2006. We identified the patients with lower limb lymphedema as described by the medical records or reported by the interviews. We obtained demographic characteristics, other medical history, cancer type, stage of cancer, lymph node dissection, chemotherapy, radiotherapy, hormone therapy and laboratory findings. Multiple logistic regression analysis was done to evaluate the risk factors for lower limb lymphedema. Results: Forty eight (19.8%) patients out of two hundred forty two had lower limb lymphedema. Those patients with lower limb lymphedema had a higher body mass index, radiotherapy history, chemotherapy history and lymph node dissection history, radical hysterectomy. Multivariate analysis revealed that body mass index, radiotherapy and lymph node dissection were independently risk factors for lower limb lymphedema after gynecologic neoplasms treatment. Conclusion: The patients who had radiotherapy, body mass index greater than 25 or lymph node dissection must be considered as potential candidates to have lower limb lymphedema in the patients after gynecologic neoplasms treatment. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measures, and the treatments. Objective: To identify the prevalence and risk factors for lower limb lymphedema in the patients after gynecologic neoplasms treatment in Korea. Methods: We retrospectively reviewed the medical records and interviewed 242 gynecologic neoplasms patients who have managed surgically and medically over a 4 year period between January 2003 and December 2006. We identified the patients with lower limb lymphedema as described by the medical records or reported by the interviews. We obtained demographic characteristics, other medical history, cancer type, stage of cancer, lymph node dissection, chemotherapy, radiotherapy, hormone therapy and laboratory findings. Multiple logistic regression analysis was done to evaluate the risk factors for lower limb lymphedema. Results: Forty eight (19.8%) patients out of two hundred forty two had lower limb lymphedema. Those patients with lower limb lymphedema had a higher body mass index, radiotherapy history, chemotherapy history and lymph node dissection history, radical hysterectomy. Multivariate analysis revealed that body mass index, radiotherapy and lymph node dissection were independently risk factors for lower limb lymphedema after gynecologic neoplasms treatment. Conclusion: The patients who had radiotherapy, body mass index greater than 25 or lymph node dissection must be considered as potential candidates to have lower limb lymphedema in the patients after gynecologic neoplasms treatment. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measures, and the treatments.
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