Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13293
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
Uterine cancer (UC) is the most common gynecologic malignancy in developed areas. The long-term survivors are commonly defined as patients who are alive for more than 5 years after diagnosis. Peripheral arterial disease (PAD) is a cardiovascular disease and the most prevalent sites of PAD are the lower extremities. In this study, we focused on critical limb ischemia (CLI) which presents a relatively severe clinical syndrome related to PAD.
The risk of CLI which causes ischemic pain or ischemic loss in the arteries of the lower extremities in long-term UC survivors remains unclear, especially in Asian patients, who are younger at the diagnosis of UC than their Western counterparts.
A nationwide population-based study was conducted to assess the risk of CLI in UC long-term survivors, defined as patients who survived for more than 5 years after diagnosis. We also assessed whether age, treatment modality, income level, comorbidities, and hormone replacement therapy (HRT) are associated with the risk of CLI.
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. The data used in this study were sourced from the records from the Taiwan National Health Insurance Research Database.
From 2000 to 2005, a total of 1889 eligible UC 5-year survivors were identified from the RCI, and 7556 controls were selected. In the younger group, the UC survivors had higher rates of comorbidities including hypertension, diabetes, hyperlipidemia, obesity and duration of HRT than the matched controls. In the younger survivors, the adjusted hazard ratios (aHRs) also revealed that the younger patients with diabetes (aHR = 2.93, P = 0.033), hypertension (aHR = 2.93, P = 0.033), and receiving HRT (aHR ≥ 2.89, P ≤ 0.038) were more likely to develop PAD. Furthermore, the aHRs revealed that the older UC survivors who received radiotherapy (RT) after surgery had at least a 2-fold higher risk of CLI compared to the matched controls. The risk of CLI was significantly increased among the survivors who were older (age at the index year > 65 years; aHR ≥ 2.48, P < 0.011), had hypertension (aHR = 2.18, P = 0.008), and received HRT for longer than 6 mo per year from the diagnosis of UC (aHR = 3.52, P = 0.020).
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 UC cancer survivors, the correlation between adjuvant RT and CLI was far weaker than the correlations of hypertension, diabetes, and long duration of HRT. Therefore, younger patients should pay special attention to monitoring CLI when using HRT.
Using a public dataset for research has inevitable limitations, and therefore we aim to use other data sources for more persuasive comparisons in the future.