GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients

Abstract

Objectives: To evaluate the incidence and risk factors for lymphedema associated with surgery for gynecologic malignancies on GOG study 244.

Methods: Women undergoing a lymph node dissection for endometrial, cervical, or vulvar cancer were eligible for enrollment. Leg volume was calculated from measurements at 10-cm intervals starting 10 cm above the bottom of the heel to the inguinal crease. Measurements were obtained preoperatively and postoperatively at 4-6 weeks, and at 3-, 6-, 9-, 12-, 18-, and 24- months. Lymphedema was defined as a limb volume change (LVC) ≥10% from baseline and categorized as mild: 10-19% LVC; moderate: 20-40% LVC; or severe: >40% LVC. Risk factors associated with lymphedema were also analyzed.

Results: Of 1054 women enrolled on study, 140 were inevaluable due to inadequate measurements or eligibility criteria. This left 734 endometrial, 138 cervical, and 42 vulvar patients evaluable for LVC assessment. Median age was 61 years (range, 28-91) in the endometrial, 44 years (range, 25-83) in the cervical, and 58 years (range, 35-88) in the vulvar group. The incidence of LVC ≥10% was 34% (n = 247), 35% (n = 48), and 43% (n = 18), respectively. The peak incidence of lymphedema was at the 4-6 week assessment. Logistic regression analysis showed a decreased risk with advanced age (p = 0.0467). An exploratory analysis in the endometrial cohort showed an increased risk with a node count >8 (p = 0.033).

Conclusions: For a gynecologic cancer, LVC decreased with age greater than 65, but increased with a lymph node count greater than 8 in the endometrial cohort. There was no association with radiation or other risk factors.

Keywords: Cervical cancer; Endometrial cancer; Lymphadenectomy; Lymphedema; Staging; Vulvar cancer.

Conflict of interest statement

Declaration of competing interest Dr. Alan Hutson received grant funding from NRG SDMC. Dr. Jeanne Carter received grant funding from grant RO1 as a co-investigator. Dr. Jane Armer received grant funding from NCI LEG study. Dr. Suzy Lockwood received grant funding from NIH ROICA 162139. Dr. Susan Nolte grant funding from NCI ROICA162139, salary support to institution, payments for patient accrual from GOG and NRG Oncology to institution. Dr. Robert Stewart received grant funding from NCI LEG study. Dr. Lari Wenzel received grant funding from NRG Oncology. All other co-authors have no conflicts of interest to declare.

Copyright © 2019 Elsevier Inc. All rights reserved.

Figures

Figure 1.. Flow Chart of Enrolled Patients.

To be eligible for risk factor analysis, patients were required to have a baseline measurement and at least four follow-up measurements.