Shi Shengjia, Lv Yang, Sun Jianhua, Wang Tianwei, Wang Mingjuan
Reproductive Center, Northwest Women's and Children's Hospital, Xi'an, Shaanxi Province 710004, PR China.
Department of Pathology, No. 942 Hospital of the Chinese People's Liberation Army Logistic Support Force, Yinchuan, Ningxia Province 750000, PR China.
Pathol Res Pract. 2025 Aug;272:156043. doi: 10.1016/j.prp.2025.156043. Epub 2025 May 27.
The purpose of our study was to explore the influence of Johnsen score on the sperm retrieval outcome (SRO) in idiopathic non-obstructive azoospermia (iNOA) patients treated with micro-TESE.
Data were collected and analyzed from a single reproductive center using a retrospective cohort study design, involving 265 male patients with iNOA who underwent microdissection testicular sperm extraction (micro-TESE) between January 2017 and December 2024. The associations between SRO and Johnsen score were investigated through univariate and multivariate logistic regression analyses, supplemented with stratified subgroup assessments. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were performed to evaluate the predictive performance of the Johnsen score-based model for successful SRO probability.
Among 265 iNOA patients undergoing micro-TESE, successful SRO were achieved in 108 cases (40.75 %), while 157 patients (59.25 %) showed negative surgical outcomes. Multivariate logistic analyses showed iNOA patients with higher Johnsen scores of testicular tissues obtained during micro-TESE were more likely to have successful SRO, this trend did not change after stratifying by age, body mass index (BMI), testis volume (TV), and testosterone (T). FSH and LH stratification revealed differential predictive capacity: significant association in FSH < 22.29 or LH< 8.55 IU/L subgroups versus null effect in FSH≥ 22.29 or LH≥ 8.55 IU/L cohorts. The predictive performance evaluation demonstrated that the Johnsen score-based nomogram achieved an area under the curve (AUC) of 0.69 in per-patient analysis, with corresponding sensitivity and specificity values of 56.9 % and 74.9 %, respectively. Decision curve analysis further confirmed the clinical superiority of this composite model, showing significantly greater net benefit across threshold probability ranges (30-85 %) compared to isolated Johnsen score assessment.
While Johnsen scoring provides a quantitative histopathological assessment of testicular spermatogenic function and demonstrates significant association with sperm retrieval outcomes (SRO), its standalone predictive capacity for micro-TESE success in idiopathic non-obstructive azoospermia (iNOA) patients remains suboptimal, necessitating integration with clinical parameters to establish a robust prognostic model.
我们研究的目的是探讨约翰森评分对接受显微睾丸精子提取术（micro-TESE）治疗的特发性非梗阻性无精子症（iNOA）患者精子获取结果（SRO）的影响。
采用回顾性队列研究设计，从单个生殖中心收集并分析数据，纳入了2017年1月至2024年12月期间接受显微睾丸精子提取术（micro-TESE）的265例iNOA男性患者。通过单因素和多因素逻辑回归分析研究SRO与约翰森评分之间的关联，并辅以分层亚组评估。进行受试者操作特征（ROC）曲线分析和决策曲线分析（DCA），以评估基于约翰森评分的模型对成功SRO概率的预测性能。
在265例接受micro-TESE的iNOA患者中，108例（40.75%）成功获取精子，而157例（59.25%）手术结果为阴性。多因素逻辑分析显示，micro-TESE术中获得的睾丸组织约翰森评分较高的iNOA患者更有可能成功获取精子，按年龄、体重指数（BMI）、睾丸体积（TV）和睾酮（T）分层后，这一趋势不变。FSH和LH分层显示出不同的预测能力：在FSH < 22.29或LH < 8.55 IU/L亚组中有显著关联，而在FSH≥22.29或LH≥8.55 IU/L队列中无影响。预测性能评估表明，基于约翰森评分的列线图在每位患者分析中曲线下面积（AUC）为0.69，相应的敏感性和特异性值分别为56.9%和74.9%。决策曲线分析进一步证实了该综合模型的临床优势，与单独评估约翰森评分相比，在阈值概率范围（30 - 85%）内显示出显著更大的净效益。
虽然约翰森评分提供了睾丸生精功能的定量组织病理学评估，并与精子获取结果（SRO）显示出显著关联，但其对特发性非梗阻性无精子症（iNOA）患者micro-TESE成功的独立预测能力仍然欠佳，需要结合临床参数建立一个强大的预后模型。
