Table 3.
Incidence and risk factors of edema and/or lymphedema of lower leg after treatment of ovarian cancer
| First author | Year | Study design | N. of OC patients (N. of total GC patients) | Stage | Diagnostic criteria | Incidence (%) | Risk factor for LEE/LLL | Comment |
|---|---|---|---|---|---|---|---|---|
| Ryan M. |
2003 |
CQ & MRR |
141 (487) |
NA |
· Diagnosed LLL |
· 7.1% (10/141) in OC |
– |
· MTFOTL: 3, 6, 12, and 60 months in 53, 18, 13, and 16% of the patients with GC. |
| · 18.3% (89/487) in all GC | ||||||||
| · 62.2% (28/45) after GLND |
· Highest rate of LLL after GLND (50–62.2%). |
|||||||
| · 50.0% (47/233) after GLND + PLND | ||||||||
| Panici PB. |
2005 |
Multi-center Italian RCT |
427 |
III, 406 (95.1%) |
· Diagnosed LLL |
· 6.5% (14/216) vs. 0% (0/211) in SL vs. LNS |
· SL compared to LNS |
· Improvement of SL on PFS, but not OS. |
| IV, 21 (4.9%) | ||||||||
| Magginoi A. |
2006 |
Multi-center Italian RCT |
268 |
I, 192 (72.7%) |
· Diagnosed LLL |
· 5.8% (8/138) vs. 0% (0/130) in SL vs. LNS |
· SL compared to LNS |
· No improvement of SL on PFS and OS. |
| II, 72 (27.3%) | ||||||||
| Beesley V. |
2007 |
PRO via mail |
234 (802) |
NA |
· PRO - LEE |
· LEE, 15.8% (37/234) |
– |
· Lowest incidence (4.7%) of LLL among GC |
| · Diagnosed LLL | ||||||||
| · LLL, 4.7% (11/234) |
· BMI is not risk factor. |
|||||||
| Tanaka T. |
2007 |
CQ & MRR |
21 (184) |
I–II, 17 (81%) |
· PRO - LEE |
· 41.7% (5/12) in RC vs. |
– |
· RC is not risk factor. This should be investigated again in larger number of patients. |
| III–IV, 4 (19%) |
· 22.2% (2/9) in non-RC |
|||||||
| Tada H. |
2009 |
Multi-center Japanese Retrospective |
135 (694) |
I–II, 75 (55.6%) |
· Diagnosed & symptomatic LLL |
· 20.7% (28/135) |
· RT, OR 1.79 (95%CI, 1.20-2.68) |
· MTFOTL: 4.6 (0.1–40.2) months |
| · LLL, 25.8 vs. 31.7% in PALND(-) vs. (+) | ||||||||
| III–IV, 60 (44.4%) | ||||||||
| Matsuo K. |
2011 |
Retrospective |
276 |
I–II, 43 (15.6%) |
· MRR |
· LEE, 6.5% (18/276) |
– |
· LEE at initial diagnosis is an important on PFS (4.9 vs. 15.3 months) and OS (5.9 and 49.1 months). |
| III–IV, 233 (84.5%) | ||||||||
| · LEE is the 14th symptoms. | ||||||||
| Karlan BY. |
2012 |
RCT |
161 |
Recurrent OC |
· Peripheral edema |
· LEE, 51-71% vs. 22% in AMG 386* vs. Control |
AMG386 administered patients |
· LEE, 51 & 71% (AMG 386 3 & 10 mg/kg QW with paclitaxel QW) vs. 22% in AMG 386* vs. Control (weekly paclitaxel (80 mg/m2 QW) |
| Achouri A. |
2012 |
Retrospective |
36 (88) |
NA |
· Diagnosed LLL |
· 5.6% (2/36) |
· Postoperative drainage, OR 0.13 (95%CI, 0.02-0.69) |
· Incidence of LLL, 11.4% and 23.5% in EC and CC. |
| · BMI, surgical approach (laparoscopy and laparotomy), PALND, SPOL, number of LND is not risk factor for LLL | ||||||||
| Lim MC. | 2013 Current study | CQ & MRR | 71 | I, 52 (73.3%) |
· PRO - LEE | · 40.8% (29/71) | – | · MTFOTL: <1, 3, 6, and 12 months in 63,18.5, 7.4, and 3.7% |
| II, 19 (26.7%) | ||||||||
| · Median duration of LEE: <6, 12, 60, and ≥60 in 27.3, 9.1, 22.7, and 40.9% |
BMI, body mass index; CC, cervical cancer; CQ, cross-sectional questionnaire; EC, endometrial cancer; GC, gynecologic cancer; GLND, groin lymph node dissection; LEE, lower extremity edema; LLL, lower leg lymphedema; LND, lymph node dissection; LNS, lymph node sampling; MRR, medical record review; MTFOTL, median time from operation to lower extremity edema; N, number; NA, not available; OC, ovarian cancer; OS, overall survival; PALN, paraaortic lymph node; PALND, paraaortic lymph node dissection; PFS, progression free survival; PLN, pelvic lymph node; PLND, pelvic lymph node dissection; PRO, patient reported outcomes; QW, once weekly; RC, retroperitoneal closure; RCT, randomized trial; RT, radiotherapy; SL, systemic pelvic and aortic lymph node dissection; SPOL, symptomatic postoperative lymphocele.
*AMG386, an investigational peptide-Fc fusion protein that neutralizes the interaction between the Tie2 receptor and angiopoietin-1/2.