Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2022; 10(36): 13293-13303
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13293
Risk of critical limb ischemia in long-term uterine cancer survivors: A population-based study
Min-Chi Chen, Jung-Jung Chang, Miao-Fen Chen, Ting-Yao Wang, Cih-En Huang, Kuan-Der Lee, Chao-Yu Chen
Min-Chi Chen, Department of Public Health, Chang Gung University, Taoyuan 333, Taiwan
Min-Chi Chen, Chao-Yu Chen, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi 612, Taiwan
Jung-Jung Chang, Division of Cardiovascular Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 612, Taiwan
Miao-Fen Chen, Department of Radiation Oncology, Change Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
Ting-Yao Wang, Cih-En Huang, Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 612, Taiwan
Cih-En Huang, Chao-Yu Chen, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Kuan-Der Lee, Department of Medicine, Taipei Medical University Hospital, Taipei 100, Taiwan
Kuan-Der Lee, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan
Kuan-Der Lee, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
Chao-Yu Chen, Department of Early Childhood Care and Education, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
Author contributions: Chen MC, Chang JJ, Chen CY, and Lee KD designed the research study; Chen MC and Lee KD performed the study concept and collected data; Chen MC analyzed the data; Chen MC, Chang JJ, and Chen CY drafted the manuscript; Chang JJ and Chen CY interpreted the data; Lee KD, Chen MF, Wang TY, and Huang CE edited and reviewed the manuscript; Chen MC and Chang JJ contributed equally to this paper; Lee KD and Chen CY contributed equally to this paper; all authors have read and approved the final manuscript.
Supported by the Chang Gung Medical Foundation, Taiwan, No. CMRPD1J0101-0102.
Institutional review board statement: This study was approved by the Institutional Review Board of Chang Gung Medical Foundation (201600205B0).
Informed consent statement: The IRB approves the waiver of the informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at b9002031@cgmh.org.tw.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao-Yu Chen, MD, Assistant Professor, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, No. 6 West Sec, Chia-Pu Road, Chiayi 612, Taiwan. b9002031@cgmh.org.tw
Received: September 25, 2022
Peer-review started: September 25, 2022
First decision: November 11, 2022
Revised: November 19, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Processing time: 92 Days and 3 Hours
Abstract
BACKGROUND

The risk of critical limb ischemia (CLI) which causes ischemic pain or ischemic loss in the arteries of the lower extremities in long-term uterine cancer (UC) survivors remains unclear, especially in Asian patients, who are younger at the diagnosis of UC than their Western counterparts.

AIM

To conduct a nationwide population-based study to assess the risk of CLI in UC long-term survivors.

METHODS

UC survivors, defined as those who survived for longer than 5 years after the diagnosis, were identified and matched at a 1:4 ratio with normal controls. Stratified Cox models were used to assess the risk of CLI.

RESULTS

From 2000 to 2005, 1889 UC survivors who received surgery alone or surgery combined with radiotherapy (RT) were classified into younger (onset age < 50 years, n = 894) and older (onset age ≥ 50 years, n = 995) groups. While compared with normal controls, the younger patients with diabetes, hypertension, and receiving hormone replacement therapy (HRT) were more likely to develop CLI. In contrast, the risk of CLI was associated with adjuvant RT, obesity, hypertension, and HRT in the older group. Among the UC survivors, those who were diagnosed at an advanced age (> 65 years, aHR = 2.48, P = 0.011), had hypertension (aHR = 2.18, P = 0.008) or received HRT (aHR = 3.52, P = 0.020) were at a higher risk of CLI.

CONCLUSION

In this nationwide study, we found that the risk factors associated with CLI were similar in both cohorts except for adjuvant RT that was negligible in the younger group, but positive in the older group. Among the survivors, hypertension, advanced age, and HRT were more hazardous than RT. Secondary prevention should include CLI as a late complication in UC survivorship programs.

Keywords: Uterine cancer; Critical limb ischemia; Radiotherapy; Survivorship

Core Tip: The risk of critical limb ischemia (CLI) in long-term uterine cancer (UC) survivors remains unclear, especially in Asian patients. In this nationwide study, a total of 1889 UC survivors were classified into younger and older groups. We found that the risk factors associated with CLI were similar in both cohorts except for adjuvant radiotherapy (RT) that was negligible in the younger group, but positive in the older group. Among these survivors, hypertension, advanced age, and hormone replacement therapy were more hazardous than RT. Secondary prevention should include CLI as a late complication in UC survivorship programs.