Risk of critical limb ischemia in long-term uterine cancer survivors: A population-based study

doi:10.12998/wjcc.v10.i36.13293

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 10, Issue 36

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (2456)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Tables (1-4) series.

Item

Count

PDF

115

WORD

HTML

1532

Tables (1-4)

271

Sum=1953

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

408

Sum=503

Dec 26, 2022 (publication date) through Jul 23, 2024

Times Cited of This Article

Times Cited (1)

Journal Information of This Article

Publication Name

World Journal of Clinical Cases

ISSN

2307-8960

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Clin Cases. Dec 26, 2022; 10(36): 13293-13303
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13293

Table 1 Characteristics of uterine cancer survivors and matched normal controls

Characteristic	UC survivors, onset age < 50 years (n = 894)	Normal controls (n = 3576)	P value	UC survivor, onset age 50 years (n = 995)	Normal controls (n = 3980)	P value
Age at index date (yr)	48.00 ± 5.63	47.82 ± 5.74		63.09 ± 6.83	63.23 ± 7.25
25-40	88 (9.84)	352 (9.84)	1.00			1.00
40-45	121 (13.53)	484 (13.53)
45-50	251 (28.08)	1004 (28.08)
50-55	434 (48.55)	1736 (48.55)
55-60				391 (39.30)	1564 (39.30)
60-65				267 (26.83)	1068 (26.83)
65-70				155 (15.58)	620 (15.58)
> 70				182 (18.29)	728 (18.29)
Urbanization
1 (least urbanized)	174 (19.46)	696 (19.46)	0.768	229 (23.01)	996 (23.01)	1.00
2	216 (24.16)	867 (24.24)		223 (22.41)	1184 (22.41)
3	300 (33.56)	1197 (33.47)		296 (29.75)	892 (29.75)
4	204 (22.82)	816 (22.82)		247 (24.82)	908 (24.82)
Income-related insurance payment
1 (lowest)	449 (50.22)	1793 (50.14)	0.600	665 (66.83)	2660 (66.83)	1.00
2	214 (23.94)	856 (23.94)		153 (15.38)	612 (15.38)
3	146 (16.33)	587 (16.41)		132 (13.27)	528 (13.27)
4 (highest)	85 (9.51)	340 (9.51)		45 (4.52)	180 (4.52)
Morbid obesity¹	44 (4.92)	111 (3.10)	0.010	18 (1.81)	123 (3.09)	0.031
Smoking-related diseases²	39 (4.36)	351 (9.82)	< 0.001	73 (7.33)	737 (18.52)	< 0.001
HRT³			0.033			0.108
0	548 (61.30)	2200 (61.52)		663 (66.63)	(69.87)
1-30 d	208 (23.27)	1158 (32.38)		229 (23.02)	774 (19.45)
31-180 d	113 (12.64)	192 (5.37)		90 (9.05)	350 (8.79)
> 180 d	25 (2.80)	26 (0.73)		13 (1.31)	75 (1.88)
Comorbidity
Hypertension	244 (27.39)	506 (14.15)	< 0.001	473 (47.54)	1779 (44.70)	0.094
Diabetes	164 (18.34)	198 (5.54)	< 0.001	236 (23.72)	816 (20.50)	0.026
Atrial fibrillation	5 (0.56)	11 (0.31)	0.268	12 (1.21)	65 (1.63)	0.312
Hyperlipidemia	95 (10.63)	210 (5.87)	< 0.001	179 (17.99)	750 (18.84)	0.532
Chronic kidney disease	7 (0.78)	15 (0.42)	0.173	11 (1.11)	35 (0.88)	0.511
CLI	8 (0.89)	19 (0.53)		19 (1.91)	66 (1.66)
Mean follow-up after index date (yr)	4.515	4.535		4.377	4.358
Incidence per 100000 person-years⁴	198.21	117.17	0.212	436.25	380.54	0.599
Treatment modality
Surgery alone	727 (81.32)			694 (69.75)
Surgery + RT	167 (18.68)			301 (30.25)

¹Morbid obesity (ICD-9 code: 278, 278.00, 278.01, and V778).

²Smoking related diagnoses (ICD-9 code: 305.1, 491.2, 492.8, 496, 523.6, 959.84, 649.0, and V15.82).

³Number of days of taking hormone replacement therapy (HRT) per year during the follow-up period. HRT was identified according to the Anatomical Therapeutic Chemical classification system and included estrogen only (G03C) and an estrogen-progesterone combination (G03F).

⁴Incidence per 100000 person-years. Data are presented as n (%) or mean ± SD.

UC survivors and the comparison group were matched by 5-year age group, sex, urbanization level, and income-related insurance payment. All P values were obtained from generalized estimating equations models. UC: Uterine cancer; RT: Radiotherapy; HRT: Hormone replacement therapy; CLI: Critical limb ischemia.

Table 2 Crude and adjusted hazard ratios for the occurrence of critical limb ischemia in the younger group using a stratified Cox model with withdrawal as a competing risk

	Crude HR (95%CI)		P value	Adjusted HR¹ (95%CI)		P value
Group (controls)	1		0.150	1		0.395
UC survivors²	1.68	(0.83-3.43)		0.66	(0.25-1.72)
Surgery alone³				0.75	(0.25-2.22)	0.601
Surgery + RT³				0.34	(0.10-1.15)	0.083
Morbid obesity	1.36	(0.35-5.37)	0.659
Smoking	1.83	(0.62-5.35)	0.271
Diabetes	4.49	(1.76-11.44)	0.002	2.93	(1.09-7.92)	0.033
Hypertension	2.89	(1.33-6.27)	0.007	3.61	(1.43-9.08)	0.006
Hyperlipidemia	3.12	(1.31-7.46)	0.010
Chronic kidney disease	4.00	(0.40-39.83)	0.237
HRT
0 d	1			1
1-30 d	1.98	(0.82-4.75)	0.127	2.89	(1.06-7.91)	0.038
30-180 d	3.67	(1.16-11.58)	0.027	5.65	(1.62-19.65)	0.006
> 180 d	22.36	(3.43-145.80)	0.001	25.75	(4.72-155.24)	< 0.001

¹Adjusted HRs and P values were obtained from a multiple stratified Cox model, which included treatment modality and significant explanatory variables only.

²All UC survivors, regardless of treatment modality.

³Treatment modalities (surgery alone and surgery with RT) were examined in the Cox model.

UC: Uterine cancer; RT: Radiotherapy; HRT: Hormone replacement therapy; HR: Hazard ratio; CI: Confidence interval; CLI: Critical limb ischemia.

Table 3 Crude and adjusted hazard ratios for the occurrence of critical limb ischemia in the older group using a stratified Cox model with withdrawal as a competing risk

	Crude HR (95%CI)		P value	Adjusted HR¹ (95% CI)		P value
Group (controls)	1		0.503	1
UC survivors²	1.17	(0.74-1.85)		1.29	(0.80-2.07)	0.299
Surgery alone³				0.93	(0.47-1.84)	0.832
Surgery + RT³				2.12	(1.13-3.95)	0.019
Morbid obesity	6.00	(2.08-17.29)	0.001	5.55	(1.82-16.94)	0.003
Smoking	0.92	(0.52-1.62)	0.769
Comorbidity
Diabetes	1.67	(1.08-2.59)	0.021
Hypertension	2.24	(1.36-3.68)	0.002	2.06	(1.24-3.43)	0.005
Hyperlipidemia	1.59	(0.98-2.57)	0.062
Chronic kidney disease	0.800	(0.11-5.63)	0.823
HRT
0 d	1			1
1-30 d	0.68	(0.38-1.24)	0.208	0.60	(1.06-7.91)	0.100
30-180 d	1.01	(0.47-2.15)	0.979	0.82	(1.62-19.65)	0.615
> 180 d	5.24	(1.81-15.23)	0.002	4.54	(1.38-14.91)	0.013

¹Adjusted hazard ratios and P values were obtained from a multiple stratified Cox model, which included treatment modality and significant explanatory variables only.

²All UC survivors, regardless of treatment modality.

³Treatment modalities (surgery alone and surgery with RT) were examined in the Cox model.

UC: Uterine cancer; RT: Radiotherapy; HRT: Hormone replacement therapy; HR: Hazard ratio; CI: Confidence interval; CLI: Critical limb ischemia.

Table 4 Adjusted hazard ratios for the occurrence of critical limb ischemia in the uterine cancer survivors using a Cox proportional hazards model (n = 1889)

	Adjusted HR	95%CI	P value
Treatment modality
Surgery alone	1		0.247
Surgery with RT	1.39	(0.80-2.42)
Age at index year (yr)
< 55	1
55-65	0.72	(0.35-1.48)	0.372
65-75	2.48	(1.23-4.99)	0.011
> 75	3.63	(1.55-8.47)	0.003
Hypertension	2.18	(1.23-3.88)	0.008
HRT
0 d	1
1-30 d	0.53	(0.25-1.15)	0.108
30-180 d	1.08	(0.45-2.58)	0.864
> 180 d	3.52	(1.22-10.13)	0.020

Adjusted hazard ratios and P values were obtained from a multiple Cox model, which included treatment modality and significant explanatory variables only. UC: Uterine cancer; RT: Radiotherapy; HRT: Hormone replacement therapy; HR: Hazard ratio; CI: Confidence interval; CLI: Critical limb ischemia.

Citation: Chen MC, Chang JJ, Chen MF, Wang TY, Huang CE, Lee KD, Chen CY. Risk of critical limb ischemia in long-term uterine cancer survivors: A population-based study. World J Clin Cases 2022; 10(36): 13293-13303
URL: https://www.wjgnet.com/2307-8960/full/v10/i36/13293.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i36.13293