Prävalenz von Komorbiditäten bei Lymphödem-Erkrankungen

Zusammenfassung

Hintergrund Komorbiditäten sind Erkrankungen, die nebeneinander auftreten, entweder voneinander unabhängig oder als Folgeerkrankung einer Indexerkrankung. Bekannte Ursachen oder Risikofaktoren für Lymphödeme (LÖ) sind u. a. maligne Erkrankungen und ihre Behandlung, Adipositas, chronisch-venöse Insuffizienz und das Lipödem. Bekannte Folgeerkrankungen sind u. a. Erysipele sowie Haut- und Nagelpilzerkrankungen. Ziel ist die Erhebung der Prävalenz von Komorbiditäten bei Lymphödem-Erkrankungen.

Methoden Retrospektive Analyse von 457 konsekutiven Fällen der Sprechstunde für Lymphödem-Erkrankungen der Hochschulambulanz einer Universitätsklinik hinsichtlich der Prävalenz von Komorbiditäten.

Ergebnisse n = 391 Fälle kamen zur Auswertung, getrennt nach Ödem-Genese, darunter n = 51 primäre Lymphödeme (pL) (Verdacht und gesichert, davon 8 gesicherte syndromale Erkrankungen) und n = 340 sekundäre Lymphödeme (sL). Das Geschlechterverhältnis in der Stichprobe war 9:1 (w:m). Während die pL-Patienten einen BMI vergleichbar der altersentsprechenden Referenzgruppe der Allgemeinbevölkerung aufwiesen, zeigten Patienten mit sL einen durchschnittlichen BMI von 33,8 und einen Anteil von 64 % adipöser Patienten (21 % mit BMI über 40). Die Prävalenz rezidivierender Erysipele war mit 7,8 bzw. 7,9 % zwischen pL und sL vergleichbar häufig. Weitere Prävalenzen wie Diagnosen aus dem muskuloskelettalen Bereich (ICD-Kapitel XIII/„M“) zeigten sich in der Stichprobe in altersgerechter Verteilung. Eine besonders hohe Prävalenz zeigten in der Gruppe der sL Schilddrüsenerkrankungen (30 %), dabei überwiegend die Schilddrüsenunterfunktion.

Diskussion Nur z. T. können das Patientenalter und Geschlecht die Prävalenzen der Komorbiditäten erklären. Auffällig beim sekundären LÖ ist die Prävalenz der Adipositas, die als Kofaktor bei der Entstehung und als aggravierender Faktor bekannt ist. Von Interesse ist auch die vergleichbare Prävalenz von Erysipelen zwischen den primären und sekundären Lymphödemen. Offenbar spielt die Genese des LÖ für die Entstehung eines Erysipels keine Rolle. Bislang kaum beschrieben, aber höchst auffällig, ist die hohe Prävalenz von Schilddrüsenerkrankungen, insbesondere der Hypothyreose, bei sekundären LÖ.

Abstract

Aim To analyse the prevalence of comorbidities in lymphoedema patients.

Methods Retrospective analysis of 457 consecutive cases of the lymphoedema clinic at a university hospital in Berlin, Germany.

Results N = 391 lymphoedema cases could be analysed. N = 51 primary lymphoedema (pL) and n = 340 secondary lymphoedema (sL) cases. The overall female to male ratio was 9:1. Patients with sL showed an average body mass index of 33,8 and a proportion of 64 % obese (21 % had a BMI over 40). The prevalence of recurring erysipelas was comparable in pL (7,8 %) and sL (7,9 %). In the group of sL there could be observed a 30 % prevalence of thyroid diseases, mostly hypothyroidism.

Discussion Age and sex can partly explain the observed prevalences. Obesity, a well-known risk factor for the development of Lymphoedema, shows noticeable prevalence rates in sL. Prevalence of recurring erysipelas is comparable in both groups and does not seem to be dependent of the lymphoedema cause. The high prevalence of hypothyroidism in sL should be subject to further prospective studies.

Schlüsselwörter

Lymphödem - primäres Lymphödem - sekundäres Lymphödem - Komorbidität - Risikofaktoren

Key words

lymphoedema - primary lymphoedema - secondary lymphoedema - comorbidity - risk factors

• Literatur

• 1 Valderas J, Starfield B, Sibbald B. et al Defining Comorbidity: Implications for Understanding Health and Health Services. Annals of Family Medicine 2009; 4: 357-363
• 2 ISL. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46: 1-11
• 3 AWMF. S2k Leitlinie Diagnostik und Therapie der Lymphödeme. AWMF Reg.-Nr 2017; 058–001
• 4 Dougados M, Soubrier M, Antunez A. et al Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 2014; 73: 62-68
• 5 Ribeiro Pereira ACP, Koifman RJ, Bergmann A. Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up. Breast 2017; 36: 67-73
• 6 Kim M, Shin KH, Jung SY. et al Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer. Cancer Res Treat 2016; 48: 1330-1337
• 7 Dean LT, Kumar A, Kim T. et al Race or Resource? BMI, Race, and Other Social Factors as Risk Factors for Interlimb Differences among Overweight Breast Cancer Survivors with Lymphedema. Journal of Obesity. vol. 2016, Article ID 8241710, 9 pages, 2016
• 8 Das N, Baumgartner RN, Riley EC. et al Treatment-related risk factors for arm lymphedema among long-term breast cancer survivors. J Cancer Surviv 2015; 9: 422-430
• 9 Rebegea L, Firescu D, Dumitru M. et al The incidence and risk factors for occurrence of arm lymphedema after treatment of breast cancer. Chirurgia (Bucur) 2015; 110: 33-37
• 10 Jung SY, Shin KH, Kim M. et al Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients. Breast Cancer Res Treat 2014; 148: 91-98
• 11 Zhu YQ, Xie YH, Liu FH. et al Systemic analysis on risk factors for breast cancer related lymphedema. Asian Pac J Cancer Prev 2014; 15: 6535-6541
• 12 Togawa K, Ma H, Sullivan-Halley J. et al Risk factors for self-reported arm lymphedema among female breast cancer survivors: a prospective cohort study. Breast Cancer Res 2014; 16: 414
• 13 Monleon S, Murta-Nascimento C, Bascuas I. et al Lymphedema Predictor Factors after Breast Cancer Surgery: A Survival Analysis. Lymphat Res Biol 2015; 13: 268-274
• 14 Boughey JC, Hoskin TL, Cheville AL. et al Risk factors associated with breast lymphedema. Ann Surg Oncol 2014; 21: 1202-1208
• 15 Ugur S, Arıcı C, Yaprak M. et al Risk factors of breast cancer-related lymphedema. Lymphat Res Biol 2013; 11: 72-75
• 16 Kim M, Kim SW, Lee SU. et al A model to estimate the risk of breast cancer-related lymphedema: combinations of treatment-related factors of the number of dissected axillary nodes, adjuvant chemotherapy, and radiation therapy. Int J Radiat Oncol Biol Phys 2013; 86: 498-503
• 17 Dominick SA, Madlensky L, Natarajan L. et al Risk factors associated with breast cancer-related lymphedema in the WHEL Study. J Cancer Surviv 2013; 7: 115-123
• 18 Bar Ad V, Dutta P, Solin L. et al Time-course of arm lymphedema and potential risk factors for progression of lymphedema after breast conservation treatment for early stage breast cancer. Breast J 2012; 18: 219-225
• 19 Shah C, Wilkinson JB, Baschnagel A. et al Factors associated with the development of breast cancer-related lymphedema after whole-breast irradiation. Int J Radiat Oncol Biol Phys 2012; 83: 1095-1100
• 20 Ahmed RL, Schmitz KH, Prizment AE. et al Risk factors for lymphedema in breast cancer survivors, the Iowa Women's Health Study. Breast Cancer Res Treat 2011; 130: 981-991
• 21 Goldberg JI, Riedel ER, Morrow M. et al Morbidity of sentinel node biopsy: relationship between number of excised lymph nodes and patient perceptions of lymphedema. Ann Surg Oncol 2011; 18: 2866-2872
• 22 Hayes SC, Rye S, Battistutta D. et al Prevalence of upper-body symptoms following breast cancer and its relationship with upperbody function and lymphedema. Lymphology 2010; 43: 178-187
• 23 Norman SA, Localio AR, Kallan MJ. et al Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomarkers Prev 2010; 19: 2734-2746
• 24 Goldberg JI, Wiechmann LI, Riedel ER. et al Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol 2010; 17: 3278-3286
• 25 Clough-Gorr KM, Ganz PA, Silliman RA. Older breast cancer survivors: factors associated with self-reported symptoms of persistent lymphedema over 7 years of follow-up. Breast J 2010; 16: 147-155
• 26 Tsai RJ, Dennis LK, Lynch CF. et al The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors. Ann Surg Oncol 2009; 16: 1959-1972
• 27 Yen TW, Fan X, Sparapani R. et al A contemporary, population-based study of lymphedema risk factors in older women with breast cancer. Ann Surg Oncol 2009; 16: 979-988
• 28 Meeske KA, Sullivan-Halley J, Smith AW. et al Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women. Breast Cancer Res Treat 2009; 113: 383-391
• 29 Kuroda K, Yamamoto Y, Yanagisawa M. et al Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study. BMC Womens Health 2017; 17: 50
• 30 Hayes SC, Janda M, Ward LC. et al Lymphedema following gynecological cancer: Results from a prospective, longitudinal cohort study on prevalence, incidence and risk factors. Gynecol Oncol 2017; 146: 623-629
• 31 Lindqvist E, Wedin M, Fredrikson M. et al Lymphedema after treatment for endometrial cancer – A review of prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2017; 211: 112-121
• 32 Kim M, Suh DH, Yang EJ. et al Identifying risk factors for occult lower extremity lymphedema using computed tomography in patients undergoing lymphadenectomy for gynecologic cancers. Gynecol Oncol 2017; 144: 153-158
• 33 Ki EY, Park JS, Lee KH. et al Incidence and Risk Factors of Lower Extremity Lymphedema After Gynecologic Surgery in Ovarian Cancer. Int J Gynecol Cancer 2016; 26: 1327-1332
• 34 Hareyama H, Hada K, Goto K. et al Prevalence, classification, and risk factors for postoperative lower extremity lymphedema in women with gynecologic malignancies: a retrospective study. Int J Gynecol Cancer 2015; 25: 751-757
• 35 Beesley VL, Rowlands IJ, Hayes SC. et al Australian National Endometrial Cancer Study Group. Incidence, risk factors and estimates of a woman's risk of developing secondary lower limb lymphedema and lymphedema-specific supportive care needs in women treated for endometrial cancer. Gynecol Oncol 2015; 136: 87-93
• 36 Yost KJ, Cheville AL, Al-Hilli MM. et al Lymphedema after surgery for endometrial cancer: prevalence, risk factors, and quality of life. Obstet Gynecol 2014; 124 (02) 307-315
• 37 Deura I, Shimada M, Hirashita K. et al Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy. Int J Clin Oncol 2015; 20: 556-560
• 38 Graf N, Rufibach K, Schmidt AM. et al Frequency and risk factors of lower limb lymphedema following lymphadenectomy in patients with gynecological malignancies. Eur J Gynaecol Oncol 2013; 34: 23-27
• 39 Akita S, Mitsukawa N, Rikihisa N. et al Early diagnosis and risk factors for lymphedema following lymph node dissection for gynecologic cancer. Plast Reconstr Surg 2013; 131: 283-290
• 40 Kim JH, Choi JH, Ki EY. et al Incidence and risk factors of lower-extremity lymphedema after radical surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Gynecol Cancer 2012; 22: 686-691
• 41 Ohba Y, Todo Y, Kobayashi N. et al Risk factors for lower-limb lymphedema after surgery for cervical cancer. Int J Clin Oncol 2011; 16: 238-243
• 42 Todo Y, Yamamoto R, Minobe S. et al Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol 2010; 119: 60-64
• 43 Tada H, Teramukai S, Fukushima M. et al Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer 2009; 9: 47
• 44 Friedman JF, Sunkara B, Jehnsen JS. et al Risk factors associated with lymphedema after lymph node dissection in melanoma patients. Am J Surg 2015; 210: 1178-1184 , discussion 1184
• 45 Deng J, Fu MR, Armer JM. et al Factors Associated with Reported Infection and Lymphedema Symptoms among Individuals with Extremity Lymphedema. Rehabil Nurs 2015; 40: 310-319
• 46 Teerachaisakul M, Ekataksin W, Durongwatana S. et al Risk factors for cellulitis in patients with lymphedema: a case-controlled study. Lymphology 2013; 46: 150-156
• 47 Okajima S, Hirota A, Kimura E. et al Health-related quality of life and associated factors in patients with primary lymphedema. Jpn J Nurs Sci 2013; 10: 202-211
• 48 Hoshika Y, Hamamoto T, Sato K. et al Prevalence and clinical features of lymphedema in patients with lymphangioleiomyomatosis. Respir Med 2013; 107: 1253-1259
• 49 Deng J, Ridner SH, Dietrich MS. et al Factors associated with external and internal lymphedema in patients with head-and-neck cancer. Int J Radiat Oncol Biol Phys 2012; 84: e319-e328
• 50 von Elm E, Altman DG, Egger M. et al STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007; 4: e296
• 51 Mensink G, Schienkiewitz A, Haftenberger M. et al Übergewicht und Adipositas in Deutschland – Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl 2013; 56: 786-794
• 52 Fuchs J, Rabenberg M, Scheidt-Nave C. Prävalenz ausgewählter muskuloskelettaler Erkrankungen – Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl 2013; 56: 678-686
• 53 Hollowell JG, Staehling NW, Flanders WD. et al Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: 489-499
• 54 Völzke H, Lüdemann J, Robinson DM. et al The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 2003; 13: 803-810
• 55 Zink A, Albrecht K. Wie häufig sind muskuloskelettale Erkrankungen in Deutschland?. Z Rheumatol 2016; 75: 346-353
• 56 Simard JF, Costenbader KH. Epidemiology and classification of systemic lupus erythematodes. In Hochberg MC, Silman AJ. et al., (Hrsg.). Rheumatology. . (6th edition) 124. Philadelphia: Elsevier; 2015: 1021-1025
• 57 Brückle W. Fibromyalgiesyndrom – die neue Leitlinie. In: Z Rheumatol. 68. 2009: 451-458
• 58 Hanewinckel R, Drenthen J, van Oijen M. et al Prevalence of polyneuropathy in the general middle-aged and elderly population. Neurology 2016; 87: 1892-1898
• 59 Janhsen K, Strube H, Starker A. Gesundheitsberichterstattung des Bundes: Hypertonie. 43. Berlin: Robert Koch-Institut; 2008: 10
• 60 Park SI, Yang EJ, Kim DK. et al Prevalence and Epidemiological Factors Involved in Cellulitis in Korean Patients With Lymphedema. Ann Rehabil Med 2016; 40: 326-333
• 61 Iurkevich NP, Savchenko TV. Lymphedema and hypothyreoidism. Klin Med (Mosk.) 1994; 72: 33-36
• 62 Jones AL, Webb DJ. Selective IgA deficiency, hypothyroidism and congenital lymphoedema. Scott Med J 1996; 41: 22-23
• 63 Al-Khader AA, Aber GM. The relationship between the ‘idiopathic oedema syndrome’ and subclinical hypothyroidism. Clin Endocrinol 1979; 10: 271-279
• 64 Wu D, Gibbs J, Corral D. et al Massive localized lymphedema: additional locations and association with hypothyroidism. Hum Pathol 2000; 31: 1162-1168
• 65 Fu M, Ridner S, Hu S. et al Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psycho-Oncology 2013; 22: 1466-1484
• 66 Rabe E, Bauersachs RM, Pannier F. et al Gesundheitsberichterstattung des Bundes: Venenerkrankungen der Beine. 44. Berlin: Robert Koch-Institut; 2009
• 67 Göpner-Reinecke C. Wissenschaftliches Institut der AOK. Frauen häufiger in physiotherapeutischer Behandlung als Männer. Pressemitteilung. 2017 zugegriffen am 28.09.2018, verfügbar unter https://aok-bv.de/presse/pressemitteilungen/2017/index_19784.html
• 68 Ritter S, Storrer D, Weigl M. et al Status Quo der Wissenschaft und Forschung in der Physikalischen Medizin und Rehabilitation in Deutschland. Phys Med Rehab Kuror 2018; 28: 219-223 .doi:10.1055/a-0596-7918
• 69 Liebl M, Schuester L, Reißhauer A. Prävalenz von Komorbiditäten bei Lymphödemerkrankungen. Phys Med Rehab Kuror 2018; 28: 246 . doi:10.1055/s-0038-1668280