A preoperative predictive model for stage IV endometriosis

Abstract

This was a retrospective study that evaluated a total of 280 patients who underwent surgery for complete removal of endometriosis to develop and validate the predictive model for stage IV endometriosis. The differences between stage I-III and stage IV endometriosis were performed by logistic regression. A model for the prediction of stage IV endometriosis was constructed, which was subsequently validated. The independent variables were visual analogue scale (VAS)≥4 [3.855, 95% confidence interval (CI): 1.675–8.871, p = 0.002], painful nodularity on uterosacral ligaments (13.954, 95% CI: 1.658–117.423, p = 0.015), and bilateral endometriosis (5.933, 95% CI: 1.931–18.225, p = 0.002). The AUC of the model was 0.777, with a sensitivity of 71.9% and specificity of 76.3% for stage IV endometriosis. Therefore, a complete collection of patient information prior to surgery, asking about pain and VAS scores, careful completion of pelvic examinations, and application of imaging techniques are conducive to better diagnosis and prediction of advanced endometriosis.

IMPACT STATEMENT

• What is already known on this subject? Endometriosis, a chronic disease causing pain and infertility, is characterised by endometrial-like tissue outside the uterine cavity, which is often treated via surgery at present. Considering the risks of surgery, it is necessary to identify patients with stage IV endometriosis through non-invasive predictive models for adequate preparation for surgery. However, there is no reliable non-invasive predictive model now, despite utilisation of patient medical history, symptoms especially pain-related ones, pelvic examinations, laboratory examinations, and images in the preoperative diagnosis of endometriosis in the clinic.

• What do the results of this study add? A model developed based on three simple, accessible and non-invasive indicators displays good performance in predicting stage IV endometriosis.

• What are the implications of these findings for clinical practice and/or further research? It is conducive to diagnosing and predicting advanced endometriosis before surgery, so as to reduce the difficulty and improve the safety of surgery.

Keywords:

• Preoperative
• prediction
• stage IV
• endometriosis
• model
• stage I–III

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Beijing Anzhen Hospital affiliated to Capital Medical University (2022061X), and informed consent was obtained from all participants involved in this study. This study was registered with the Chinese Clinical Trial Registry (Registration number is ChiCTR2200058414). All methods were performed in accordance with relevant guidelines and regulations. All information obtained from study participants was kept confidential, names or personal identifiers were not included in the study. The medical record number was used to trace back the participants if needed.

Author contributions

ZJ and ZH designed the study. ZJ, ZH, BZL, KJ, WW and GJQ acquired the data. BZL, KJ, WW their assistants completed the operation and scoring. ZH performed the statistical analyses. ZH wrote the manuscript and submitted the manuscript. ZJ revised the paper. All authors approved the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and analysed during the current study are not publicly available due to the privacy protection of the subjects, but are available from the corresponding author on reasonable request.

Additional information

Funding

No specific funding was obtained.