Recurrence after hysteroscopic myomectomy for FIGO type II submucosal myomas: a retrospective cohort study.
The study identifies key factors associated with recurrence of myomas after surgery and presents a nomogram that may help predict individual recurrence risk over three years.
Where it sits
this study against the rest of the gonadorelin (gnrh) corpusSummary and findings
This study investigated factors influencing recurrence of FIGO type II submucosal myomas after hysteroscopic myomectomy in 120 patients. The study found that 30 recurrences occurred, primarily within 24 months post-surgery. A nomogram was developed to predict 3-year recurrence risk based on identified risk factors.
Abstract
<h4>Background</h4>We aimed to investigate the influencing factors for recurrence of International Federation of Gynaecology and Obstetrics (FIGO) type II submucosal myoma with a diameter of 4-5 cm following hysteroscopic myomectomy, and to establish an individualised prediction model for the risk of postoperative 3-year recurrence.<h4>Methods</h4>In this single-centre retrospective cohort study, patients undergoing hysteroscopic myomectomy between January 2017 and June 2025 were included. Recurrence-free survival was assessed using the Kaplan-Meier method. Candidate variables were initially screened using LASSO-Cox regression with 10-fold cross-validation for λ selection, followed by multivariable Cox regression. Multicollinearity among candidate predictors was assessed using variance inflation factors. A nomogram was constructed to predict 3-year recurrence risk. Model performance was evaluated by bootstrap validation, including discrimination (C-index), calibration (calibration curve and Brier score), and clinical utility (decision curve analysis).<h4>Results</h4>A total of 120 patients were included, and 30 recurrences occurred, mainly within 24 months after surgery. Multivariate Cox analysis identified larger myoma diameter, multiple myomas, staged operation, and longer operation time as independent risk factors, whereas older age and postoperative gonadotropin-releasing hormone agonist (GnRHa)/dienogest therapy were protective factors (<i>P</i> < 0.05). The nomogram showed favourable discrimination, calibration, and clinical net benefit.<h4>Conclusions</h4>Recurrence after hysteroscopic myomectomy was associated with tumour characteristics, surgical complexity, and postoperative hormonal therapy. The nomogram showed favourable performance, with a bootstrap-corrected C-index of 0.811, a 3-year Brier score of 0.099, and clinical net benefit across threshold probabilities of approximately 0.05-0.45. This exploratory model may support individualised 3-year recurrence risk stratification and guide follow-up and adjuvant treatment planning.
Background
This paper addresses the recurrence of FIGO type II submucosal myomas following hysteroscopic myomectomy, a procedure often performed to treat these myomas. Previous studies have identified various factors that may influence recurrence, but a comprehensive model for predicting individual risk has not been established. Understanding these factors is crucial for improving patient outcomes and tailoring follow-up care.
Methods
This was a single-centre retrospective cohort study involving 120 patients who underwent hysteroscopic myomectomy between January 2017 and June 2025. Recurrence-free survival was evaluated using the Kaplan-Meier method, and candidate variables were screened using LASSO-Cox regression. The study assessed multicollinearity among predictors and constructed a nomogram to predict 3-year recurrence risk.
Results
Out of 120 patients, 30 recurrences were observed, primarily occurring within 24 months post-surgery. Multivariate Cox analysis revealed that larger myoma diameter, multiple myomas, staged operation, and longer operation time were independent risk factors for recurrence, with p-values less than 0.05. The nomogram demonstrated a bootstrap-corrected C-index of 0.811, indicating good discrimination.
Interpretation
The findings align with existing literature that suggests tumor characteristics and surgical complexity influence recurrence rates. While the C-index of 0.811 indicates a statistically significant predictive model, the clinical significance of this effect size should be interpreted cautiously. Limitations such as the retrospective design and single-center nature may restrict the applicability of the results in broader clinical practice.
Key findings
- 30 recurrences occurred within 24 months after surgery, n=120.
- Bootstrap-corrected C-index of 0.811 for the nomogram.
- 3-year Brier score of 0.099 for the nomogram.
- Larger myoma diameter, multiple myomas, staged operation, and longer operation time were identified as independent risk factors, p<0.05.
Limitations
- Retrospective design limits causal inference.
- Single-center study may affect generalizability.
- No long-term follow-up beyond three years reported.