RESUMO
AIM: To evaluate risk factors for lymphoedema development in the upper and lower limbs and to propose a model that predicts risk of lymphoedema after lymphadenectomy. PATIENTS: We studied 84 patients who had undergone radical lymphadenectomies for cutaneous melanoma from 1990 to 2008. METHODS: The patients included underwent an evaluation that consisted of measurement of limb volume using perimetry, application of the manually acquired perimetric data to the truncated-cone formula, and data from medical records. RESULTS: Using multivariate analysis, we obtained the following risk factors for the development of lymphoedema: reconstruction with graft (p = 0.013), Breslow depth >4mm (p = 0.029), ilioinguinal lymphadenectomy (p = 0.037) and wound infection (p = 0.036). We assigned points to each factor as dictated by the value of the regression coefficient, as follows: infection (1 point), ilioinguinal lymphadenectomy and Breslow >4mm (2 points each) and reconstruction with graft (3 points). The mathematical model for predicting lymphoedema risk in the limb ipsilateral to the lymphadenectomy was based on risk groups, defined by score: low risk = 0 point (for which we calculated an 8.3% chance of developing lymphoedema), intermediate risk = 1-2 points (26.8%), high risk = 3 points (52.9%) and very high risk = 4 or more points (88.9%). CONCLUSIONS: This study identified a melanoma thickness >4mm, graft reconstruction, ilioinguinal lymphadenectomy and infection as risk factors for lymphoedema. From these factors, we constructed a mathematical model that successfully predicted risk of post-lymphadenectomy lymphoedema. The combined presence of these risk factors increased the chance of developing lymphoedema.
Assuntos
Excisão de Linfonodo , Linfedema/epidemiologia , Melanoma/cirurgia , Modelos Biológicos , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Criança , Pré-Escolar , Extremidades , Feminino , Humanos , Canal Inguinal , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Adulto JovemRESUMO
The objective of this study was to assess the frequency of micrometastatic disease (MID) in pelvic lymph nodes (PLNs) in carcinoma of the uterine cervix (CUC) and to determine the risk of recurrence. The PLNs from 289 patients with CUC (IB and IIA) were studied. Each PLN was assessed via immunohistochemistry using a single histologic section (AE1/AE3). Metastatic deposits were measured and the disease status was classified into three groups: 1) absence of metastatic disease (MOD); 2) MID, one or more metastatic PLN with only isolated tumor cells and/or micrometastases (up to 2 mm); and 3) macrometastatic disease (MAD), presence of one or more metastatic PLN with macrometastases (more than 2 mm). Eleven patients (3.8%) were classified as having MID and 37 (12.8%) as having MAD. The 5-year disease-free survival (DFS) rates for MOD, MAD, and MID were 88.7%, 80.4%, and 50.0%, respectively (P < 0.001). The Cox proportional hazards model showed that MID was an independent variable for recurrence when adjusted for MAD, depth of tumor invasion, severity of inflammatory reaction, and use of adjuvant radiotherapy. We conclude that the frequency of MID in PLN was low. However, patients with MID presented a high risk of recurrence and reduced DFS.