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. 2021 Oct 11;10(20):4647.
doi: 10.3390/jcm10204647.

Lymphedema in Endometrial Cancer Survivor: A Nationwide Cohort Study

Su-Jeong Lee  1 , Jun-Pyo Myong  2 , Yun-Hee Lee  3 , Eui-Jin Cho  1 , Sung-Jong Lee  4 , Chan-Joo Kim  1 , Jin-Hwi Kim  1
Affiliations

Lymphedema in Endometrial Cancer Survivor: A Nationwide Cohort Study

Su-Jeong Lee et al. J Clin Med. .

Abstract

Background: Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in patients with endometrial cancer.

Methods: We conducted a nationwide, retrospective cohort study of women with endometrial cancer who underwent cancer-direct treatment using the Korean National Health Insurance Service (NHIS) database. Patients were categorized by age, region, income, and treatment modality. Cox proportional hazards regression models were used to analyze the incidence and risk factors of lymphedema. We also analyzed utilization of health care resources for lymphedema using diagnostic and treatment claim codes.

Results: A total of 19,027 patients with endometrial cancer were evaluated between January 2004 and December 2017. Among them, 2493 (13.1%) developed lymphedema. Age (<40 years, adjusted odds ratio [aOR] = 1 vs. 40-59 years, aOR = 1.413; 95% confidence interval (CI) 1.203-1.66 vs. 60+ years, aOR = 1.472; 95% CI 1.239-1.748) and multimodal treatment (surgery only, aOR = 1 vs. surgery + radiation + chemotherapy, aOR = 2.571; 95% CI 2.27-2.912) are considered to be possible risk factors for lymphedema in patients with endometrial cancer (p < 0.001). The utilization of health care resources for the treatment of lymphedema has increased over the years.

Conclusions: Lymphedema is a common complication affecting women with endometrial cancer and leads to an increase in national healthcare costs. Post-treatment surveillance of lymphedema, especially in high-risk groups, is needed.

Keywords: Korea; endometrial cancer; health care cost; lymphedema; sentinel lymph nodes.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A schematic illustration of participant selection for the present study. A total of 34,540 patients with endometrial cancer were included in the analyses. Patients who were diagnosed before 2003, those with other primary cancers, or those with lymphedema diagnosed before cancer diagnosis were excluded.
Figure 2
Figure 2
Cumulative incidence of lymphedema in endometrial cancer patients.
Figure 3
Figure 3
Cumulative incidence of lymphedema according to age at diagnosis, residence, income quartile, and endometrial cancer treatment modality. (a). Cumulative incidence of lymphedema according to age. (1; 0–39 years, 2; 40–59 years, 3; 60+ years old) (b). Cumulative incidence of lymphedema according to residence. (1; urban, 2; rural) (c). Cumulative incidence of lymphedema according to income. (1; lowest income, 2; lower, 3; upper, 4; highest) (d). Cumulative incidence of lymphedema according to treatment modalities. (1; Surgery, 2; Radiation, 3; Chemotherapy, 4; S + R, 5; S + C, 6; R + C, 7; S + R + C, 8; other).
Figure 4
Figure 4
The trend of annual treatment cost for lymphedema in endometrial cancer.
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