Comparison of Staging Systems to Assess Lymphedema Caused by Cancer Therapies, Lymphatic Filariasis, and Podoconiosis
Comparison of Staging Systems to Assess Lymphedema Caused by Cancer Therapies, Lymphatic Filariasis, and Podoconiosis
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DOI：
10.1089/lrb.2018.0063
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发表时间：
2019-10-01
影响因子：
1.4
通讯作者：
Kelly-Hope, Louise
中科院分区：
文献类型：
--
作者：
Douglass, Janet;Kelly-Hope, Louise
背景：淋巴水肿是由于淋巴流动障碍引起的皮肤和皮下组织的疾病。任何人都可能受到影响，原因包括切除或照射淋巴结时的癌症治疗，寄生虫病淋巴丝虫病，以及暴露在刺激性土壤中造成的损害，称为足锥虫病。明显的淋巴水肿是进行性的，是受影响人群残疾、耻辱和社会孤立的主要原因。尽管淋巴水肿中结缔组织改变的发病机制将遵循类似的过程，无论病因是什么，但有几个系统用于分期进展。这些分期系统的差异导致淋巴水肿严重程度的报告不一致，并阻止了对研究结果的荟萃分析。在全球卫生环境中，慢性病的综合发病率管理对于满足受影响人群的需求和卫生保健系统的可持续发展至关重要。每个系统内分期标准的临床描述符可以帮助临床医生进行评估，并为淋巴水肿研究人员报告的一致性提供一种格式。方法和结果：回顾了肿瘤学、丝虫病和足癣环境中使用的淋巴水肿分期系统，并描述了每个系统使用的评估技术、诊断程序和临床观察。比较了最常用的分期系统，以确定相似性，并提出了淋巴水肿分期的矩阵方法。结论：一个通用的分期系统将有助于更一致地报道由多种原因引起的淋巴水肿的研究和临床治疗。
Background: Lymphedema is a disease of the skin and subcutaneous tissue resulting from a disturbance in lymph flow. Anyone can be affected, and causes include cancer therapy when lymph nodes are removed or irradiated, the parasitic disease lymphatic filariasis, and damage caused by exposure to irritant soils known as podoconiosis. Manifest lymphedema is progressive and a major contributor to disability, stigma, and social isolation for affected people. Although the pathogenesis of connective tissue changes in lymphedema will follow a similar course regardless of the disease of causation, several systems are used to stage progression. Disparity in these staging systems leads to inconsistency in reporting of the severity of lymphedema and prevents meta-analysis of research results. In the global health environment, integrated morbidity management for chronic illness is essential to meet the needs of affected people and to be sustainable for health care systems. Clinical descriptors for staging criteria within each system may assist clinicians in assessment and provide a format for consistency in reporting by lymphedema researchers. Methods and Results: Lymphedema staging systems used in oncology, filariasis, and podoconiosis settings were reviewed and the assessment techniques, diagnostic procedures, and clinical observations used by each system are described. The most commonly used staging systems are compared to identify similarities, and a matrix approach to lymphedema staging is proposed. Conclusion: A universal staging system would contribute to more consistent reporting of research on and clinical management of lymphedema arising from multiple causes.