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Table 3 Risk factors of lymphedema

From: Prevalence and incidence of cancer related lymphedema in low and middle-income countries: a systematic review and meta-analysis

Risk factor Author Risk ratio/Hazard ratio Stage and Measurement
1. Arm Lymphedema
BMI > 25
Age > 60
Number of metastatic LNs
Having a Breast/Chest-wall RT
Having Axillary RT
Lumpectomya
(KİBar, Aras et al. 2015) [27] 5.911 (OR1.698–20.583)
3.680 (OR1.076–12.583)
1.115 (OR1.043–1.192)
3.249 (OR1.742–6.060)
4.375 (OR1.439–13.306)
0.294 (OR0.062–1.402)a
Patients undergoing Level III Mastectomy/ Lumpectomy/ Chemotherapy/ Radiotherapy
Arm circumference measurement
Having mastectomy (ALND) + RT (Ozcinar, Guler et al. 2012) [29] Patients with ALND + RT had statistically increased rate
of lymphedema than patients with ALND and without RT
(p = 0.030)
Stage I, II who underwent mastectomy
Arm circumference measurement
BMI > 25
Axillary Radiotherapy
Stage of the cancer (I-III)
(Ozaslan and Kuru 2004) [30] 5.55 (RR2.28–13.51)
2.75 (RR1.48–5.08)
Not significant
Stage I-III
Arm circumference measurement
Number of lymph node removed
16–25
Removal > 25
Adjuvant RT + LND
Chemotherapy
(Rebegea, Firescu et al. 2015) [21] 1.85 (OR1.27–2.71)
4.88 (OR2.25–10.58)
3.87 (OR1.39–6.51)
1.45 (OR1.12–2.24)
Stages I-IV
Arm circumference measurement
Presence of seroma after breast cancer surgery
Staging of cancera
Time after surgery
(Paiva, Rodrigues et al. 2013) [34] 2.71(PR1.49–4.91)
1.15(PR0.78–2.92)a
Surgery for > 5 years is 9.7 times higher frequency than < 5 years
Women undergoing oncology follow up
Perimetry
Staging (Locally advanced III)a
Post RT skin necrosis
(Khanna, Gupta et al. 2019) [41] 2.21(OR 0.54–9.04)a
4.34 (OR1.07–17.65)
Early and locally advanced stages
Arm circumference measurement
Higher BMI
Increasing number of lymph nodes dissected
Higher nodal ratio
Regional Lymph Node Radiation (RLNR)
(Rastogi, Jain et al. 2018) [42] 1.191 (HR0.809–1.755)
1.445 (HR1.116–1.872)
1.135 (HR1.037–1.243)
1.020 (HR0.042–24.571)
Stage II – III
Arm circumference measurement
Axillary RT
Presence of co-morbid condition
(Deo, Ray et al. 2004) [45] 0.0709 (HR2.3222–7.1601)
0.1593 (HR1.1441–2.9369)
Stage I-III
Arm circumference measurement
Engaging in moderate to severe physical activity
BMI of ≥25
Invasiveness of the tumor
Modified Radical Mastectomy
Having radiotherapy
Past history of limb damage
Number of lymph nodes removed
(Honarvar, Sayar et al. 2016) [47] 14.0 (OR2.6–73.3)
4.2 (OR2.0–8.7)
13.7 (OR7.3–25.6)
4.3 (OR2.3–7.9)
3.9 (OR1.8–8.2)
1.7 (OR0.9–3.1)
1.1 (OR1.0–1.1)
Women with breast cancer
Arm circumference measurement
BMI (Ay, Kutun et al. 2014) [28] BMI of 25–29.9 was 1.445 times
more likely to develop lymphoedema than a patient with a BMI
of < 17.9 (p < 0.001), and a patient with a BMI of 30–34.9 was
6.643 times more likely to develop it than a patient with a BMI of
< 17.9 (p < 0.001).
Stage I & II
Arm circumference measurement
2. Leg Lymphedema
Age
BMI
Staginga
(de Melo Ferreira, de Figueiredo et al. 2012) [49] 1.09 (OR1.00–1.18)
1.34 (OR1.01–1.77)
0.33 (OR0.02–5.33)a
Stage I-IV
Clinical diagnosis
  1. aNot significant in the final model
  2. RT Radiotherapy, LN Lymph node, BMI Body mass index; Lymph node dissection