Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
Ann Palliat Med. 2021 Nov;10(11):11628-11634. doi: 10.21037/apm-21-2747.
Currently, determining the postoperative recurrence of endometrial polyps is an unresolved issue, so we screened the risk factors to establish a nomogram for clinical practice.
From January 2012 to June 2020, 133 patients who underwent hysteroscopic endometrial polypectomy and diagnostic curettage due to suspicious endometrial polyps for the first time and were pathologically diagnosed as endometrial polyps after surgery. All patients were followed up for more than 12 months, and 9 (6.77%) cases were lost to follow-up. Logistic regression analysis of clinical factors was performed to screen independent risk factors and construct a column chart to predict the probability of adverse events. The fitting curve was used to validate the line graph.
The ratio of patients with body mass index (BMI) <28 kg/m2 in the recurrence group was lower than in the non-recurrence group (P=0.028), as was the proportion of patients with polyp <2 cm (recurrence group vs. non-recurrence group, P=0.027) and the proportion of patients in the recurrence group treated with progesterone after surgery compared with non-recurrence group (P=0.003). However, the proportion of endometrial thickening in the recurrence group was higher than in the non-recurrence group (P=0.006). Age, BMI, polyp size, and endometrial thickening were independent risk factors for recurrence after endometrial polypectomy [odds ratio (OR) >1, P<0.05]. Progesterone therapy after surgery was an independent protective factor for recurrence after endometrial polypectomy (OR <1, P<0.05). Our nomogram was based on age, BMI, polyp size, endometrial thickening, and postoperative progesterone treatment. The maximum offset between the predicted curve and the ideal curve was 0.083, and the minimum offset between the model and the ideal model was 0.021. The height of the linear curve was close to that of the ideal curve. The U test showed P=0.898, greater than 0.05, indicating that the nomogram model passed the calibration test. The receiver operating characteristic curve was 0.886.
Our nomogram based on age, BMI, polyp size, progesterone treatment, and endometrial thickening accurately predicted the risk of polyp recurrence after endometrial polypectomy and can be applied in clinical practice.
目前，确定子宫内膜息肉的术后复发仍是一个悬而未决的问题，因此我们筛选了风险因素，以建立一个列线图供临床使用。
本研究纳入了 2012 年 1 月至 2020 年 6 月期间因疑似子宫内膜息肉首次接受宫腔镜子宫内膜息肉切除术和诊断性刮宫术且术后病理诊断为子宫内膜息肉的 133 例患者。所有患者的随访时间均超过 12 个月，其中 9 例（6.77%）失访。对临床因素进行 logistic 回归分析，筛选独立的危险因素，并构建列线图预测不良事件的概率。使用拟合曲线验证折线图。
复发组中 BMI<28kg/m2 的患者比例低于未复发组（P=0.028），息肉<2cm 的患者比例（复发组与未复发组，P=0.027）和术后接受孕激素治疗的患者比例（复发组与未复发组，P=0.003）均低于未复发组。然而，复发组的子宫内膜增厚比例高于未复发组（P=0.006）。年龄、BMI、息肉大小和子宫内膜增厚是子宫内膜息肉切除术后复发的独立危险因素[优势比（OR）>1，P<0.05]。术后孕激素治疗是子宫内膜息肉切除术后复发的独立保护因素（OR<1，P<0.05）。我们的列线图基于年龄、BMI、息肉大小、子宫内膜增厚和术后孕激素治疗。预测曲线与理想曲线之间的最大偏差为 0.083，模型与理想模型之间的最小偏差为 0.021。线性曲线的高度与理想曲线的高度接近。U 检验显示 P=0.898，大于 0.05，表明列线图模型通过了校准检验。受试者工作特征曲线为 0.886。
我们的列线图基于年龄、BMI、息肉大小、孕激素治疗和子宫内膜增厚，可以准确预测子宫内膜息肉切除术后息肉复发的风险，并可应用于临床实践。
