Obstet Gynecol Sci.  2017 Sep;60(5):440-448. 10.5468/ogs.2017.60.5.440.

Nomogram predicting risk of lymphocele in gynecologic cancer patients undergoing pelvic lymph node dissection

• Yoo B
• Ahn H
• Kim M
• Suh DH
• Kim K
• No JH
• Kim YB

• KMID: 2393843
• DOI: http://doi.org/10.5468/ogs.2017.60.5.440

Abstract

OBJECTIVE
The purpose of this study is to estimate the risk of postoperative lymphocele development after lymphadenectomy in gynecologic cancer patients through establishing a nomogram.
METHODS
We retrospectively reviewed 371 consecutive gynecologic cancer patients undergoing lymphadenectomy between 2009 and 2014. Association of the development of postoperative lymphocele with clinical characteristics was evaluated in univariate and multivariate regression analyses. Nomograms were built based on the data of multivariate analysis using R-software.
RESULTS
Mean age at the operation was 50.8±11.1 years. Postoperative lymphocele was found in 70 (18.9%) patients. Of them, 22 (31.4%) had complicated one. Multivariate analysis revealed that hypertension (hazard ratio [HR], 3.0; 95% confidence interval [CI], 1.5 to 6.0; P=0.003), open surgery (HR, 3.2; 95% CI, 1.4 to 7.1; P=0.004), retrieved lymph nodes (LNs) >21 (HR, 1.8; 95% CI, 1.0 to 3.3; P=0.042), and no use of intermittent pneumatic compression (HR, 2.7; 95% CI, 1.0 to 7.2; P=0.047) were independent risk factors for the development of postoperative lymphocele. The nomogram appeared to be accurate and predicted the lymphocele development better than chance (concordance index, 0.754). For complicated lymphoceles, most variables which have shown significant association with general lymphocele lost the statistical significance, except hypertension (P=0.011) and mean number of retrieved LNs (29.5 vs. 21.1; P=0.001). A nomogram for complicated lymphocele showed similar predictive accuracy (concordance index, 0.727).
CONCLUSION
We developed a nomogram to predict the risk of lymphocele in gynecologic cancer patients on the basis of readily obtained clinical variables. External validation of this nomogram in different group of patients is needed.

Keyword

Lymphocele; Gynecologic Neoplasms; Nomograms; Lymph node excision

MeSH Terms

Female
Genital Neoplasms, Female
Humans
Hypertension
Lymph Node Excision*
Lymph Nodes*
Lymphocele*
Multivariate Analysis
Nomograms*
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Nomogram for the risk of development of postoperative lymphocele in gynecologic cancer patients. IPC, intermittent pneumatic compression; LN, lymph node; PLN, pelvic lymph node.

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  Fig. 2 Receiver operating characteristic curve assessing the predictive accuracy of the nomogram. AUC, area under the curve.

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  Fig. 3 Calibration plot of prediction model for probability of postoperative lymphocele development.

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