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

Jay W. Carlson, James Kauderer, Alan Hutson, Jeanne Carter, Jane Armer, Suzy Lockwood, Susan Nolte, Bob R. Stewart, Lari Wenzel, Joan Walker, Aimee Fleury, Albert Bonebrake, John Soper, Cara Mathews, Oliver Zivanovic, Wm Edward Richards, Annie Tan, David S. Alberts, Richard R. Barakat

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalGynecologic oncology
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Lymphedema
Cohort Studies
Extremities
Neoplasms
Incidence
Vulvar Neoplasms
Gynecologic Surgical Procedures
Heel
Groin
Endometrial Neoplasms
Lymph Node Excision
Uterine Cervical Neoplasms
Leg
Logistic Models
Lymph Nodes
Regression Analysis
Radiation

Keywords

  • Cervical cancer
  • Endometrial cancer
  • Lymphadenectomy
  • Lymphedema
  • Staging
  • Vulvar cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Carlson, J. W., Kauderer, J., Hutson, A., Carter, J., Armer, J., Lockwood, S., ... Barakat, R. R. (Accepted/In press). GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecologic oncology. https://doi.org/10.1016/j.ygyno.2019.10.009

GOG 244-The lymphedema and gynecologic cancer (LEG) study : Incidence and risk factors in newly diagnosed patients. / Carlson, Jay W.; Kauderer, James; Hutson, Alan; Carter, Jeanne; Armer, Jane; Lockwood, Suzy; Nolte, Susan; Stewart, Bob R.; Wenzel, Lari; Walker, Joan; Fleury, Aimee; Bonebrake, Albert; Soper, John; Mathews, Cara; Zivanovic, Oliver; Richards, Wm Edward; Tan, Annie; Alberts, David S.; Barakat, Richard R.

In: Gynecologic oncology, 01.01.2019.

Research output: Contribution to journalArticle

Carlson, JW, Kauderer, J, Hutson, A, Carter, J, Armer, J, Lockwood, S, Nolte, S, Stewart, BR, Wenzel, L, Walker, J, Fleury, A, Bonebrake, A, Soper, J, Mathews, C, Zivanovic, O, Richards, WE, Tan, A, Alberts, DS & Barakat, RR 2019, 'GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients', Gynecologic oncology. https://doi.org/10.1016/j.ygyno.2019.10.009
Carlson, Jay W. ; Kauderer, James ; Hutson, Alan ; Carter, Jeanne ; Armer, Jane ; Lockwood, Suzy ; Nolte, Susan ; Stewart, Bob R. ; Wenzel, Lari ; Walker, Joan ; Fleury, Aimee ; Bonebrake, Albert ; Soper, John ; Mathews, Cara ; Zivanovic, Oliver ; Richards, Wm Edward ; Tan, Annie ; Alberts, David S. ; Barakat, Richard R. / GOG 244-The lymphedema and gynecologic cancer (LEG) study : Incidence and risk factors in newly diagnosed patients. In: Gynecologic oncology. 2019.
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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.",
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author = "Carlson, {Jay W.} and James Kauderer and Alan Hutson and Jeanne Carter and Jane Armer and Suzy Lockwood and Susan Nolte and Stewart, {Bob R.} and Lari Wenzel and Joan Walker and Aimee Fleury and Albert Bonebrake and John Soper and Cara Mathews and Oliver Zivanovic and Richards, {Wm Edward} and Annie Tan and Alberts, {David S.} and Barakat, {Richard R.}",
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T2 - Incidence and risk factors in newly diagnosed patients

AU - Carlson, Jay W.

AU - Kauderer, James

AU - Hutson, Alan

AU - Carter, Jeanne

AU - Armer, Jane

AU - Lockwood, Suzy

AU - Nolte, Susan

AU - Stewart, Bob R.

AU - Wenzel, Lari

AU - Walker, Joan

AU - Fleury, Aimee

AU - Bonebrake, Albert

AU - Soper, John

AU - Mathews, Cara

AU - Zivanovic, Oliver

AU - Richards, Wm Edward

AU - Tan, Annie

AU - Alberts, David S.

AU - Barakat, Richard R.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Cervical cancer

KW - Endometrial cancer

KW - Lymphadenectomy

KW - Lymphedema

KW - Staging

KW - Vulvar cancer

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