A prognostic nomogram for assessing the risk of recurrence after laparoscopic myomectomy.

OBJECTIVE

This study aimed to identify key predictors of uterine fibroid (UF) recurrence following laparoscopic myomectomy (LM) in reproductive-age women and to construct a predictive nomogram to support individualized clinical decision-making.

METHODS

This retrospective cohort study included 459 women who underwent LM. Recurrence of UFs and risk of recurrence were analyzed. Time to recurrence, defined as the interval between surgery and imaging-confirmed regrowth, was the primary time-to-event outcome. Multivariate Cox regression and Kaplan-Meier analyses identified significant predictors of recurrence, which were used to develop a predictive nomogram.

RESULTS

Out of 459 patients, 69 experienced recurrence during a median follow-up of 15.8 months. Significant recurrence predictors included age (30-40 years, HR = 1.74, p = 0.041; 18-30 years, HR = 1.88, p = 0.047); fibroid count (≥ 3 fibroids, HR = 2.73, p = 0.001); and fibroid size (≥ 5 cm, HR = 2.84, p < 0.001). The predictive nomogram, integrating age, number, and size of UFs, showed a C-index of 0.752 and area under the curve (AUC) values for 1-, 2-, and 3-year recurrence of 0.710, 0.783, and 0.797, respectively, reflecting robust predictive performance. Calibration curves confirmed the nomogram's accuracy in aligning predicted with observed outcomes.

CONCLUSION

The study developed a validated nomogram for predicting recurrence in UFs patients after LM, incorporating age, number, and size of UFs to enhance clinical decision-making.