Preoperative CA125 as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery

Figures & data

Figure 1. Flow chart of patient selection.

Table 1. Clinicopathological features.

Variable	Total cohort (n = 502)	Recurrence group (n = 133)	Non-recurrence group (n = 369)	Test value	P
Age (years)	43.7 ± 5.3	42.3 ± 5.4	44.3 ± 5.1	−3.652	<0.001
BMI (kg/m^2)				2.288	0.130
>24	209 (41.6)	48 (36.1)	161 (43.6)
≤24	293 (58.4)	85 (63.9)	208 (56.4)
Pre-FUAS dysmenorrhea				11.050	<0.001
Yes (%)	381 (75.9)	115 (86.5)	266 (72.1)
No (%)	121 (24.1)	18 (13.5)	103 (27.9)
Pre-FUAS menorrhagia				2.595	0.107
Yes (%)	272 (54.2)	80 (60.2)	192 (52.0)
No (%)	230 (45.8)	53 (39.8)	177 (48.0)
Uterus position				0.476	0.788
Ante-verted (%)	292 (58.2)	74 (55.7)	218 (59.1)
Retro-verted (%)	192 (38.2)	49 (36.8)	143 (38.8)
Neutral (%)	18 (3.6)	10 (7.5)	8 (2.1)
Type of adenomyotic lesions				6.612	0.010
Focal (%)	174 (34.7)	34 (25.6)	140 (37.9)
Diffuse (%)	328 (65.3)	99 (74.4)	229 (62.1)
Adenomyosis location				3.070	0.381
Anterior (%)	152 (30.3)	34 (25.6)	118 (32.0)
Posterior (%)	287 (57.1)	78 (58.6)	209 (56.6)
Fundus (%)	41 (8.2)	13 (9.8)	28 (7.6)
Anterior-Posterior (%)	22 (4.4)	8 (6.0)	14 (3.8)
Hyperintensity on T2WI				0.004	0.952
Yes (%)	102 (20.3)	27 (20.3)	74 (20.1)
No (%)	400 (79.7)	106 (79.7)	295 (79.9)
Endometriosis				3.233	0.072
Yes (%)	81 (16.1)	28 (21.1)	53 14.4)
No (%)	421 (83.9)	105 (78.9)	316 (85.6)
Subcutaneous fat thickness (mm)	19.3 ± 9.3	18.8 ± 7.5	19.5 ± 9.6	−0.717	0.474
Distance (mm)	24.1 ± 14.8	24.0 ± 15.2	24.1 ± 14.7	−0.055	0.956
Uterus volume (cm3)	231.3 ± 124.5	248.6 ± 128.2	225.1 ± 122.7	1.855	0.064
Adenomyosis volume (cm3)	53.6 ± 55.7	61.4 ± 53.4	50.8 ± 56.4	1.839	0.067
Preoperative CA125 (U/ml)	90.2 ± 107.5	117.3 ± 120.3	81.0 ± 101.3	2.930	0.004
Total sonication time (s)	391.0 ± 274.2	405.4 ± 272.9	386.2 ± 274.9	0.695	0.488
Average sonication power (s/h）	431.1 ± 194.6	442.2 ± 329.3	426.9 ± 111.7	0.526	0.600
Gray scale change					0.037
Massive (%)	295 (58.8)	68 (51.1)	227 (61.5)	4.355
Uniform (%)	207 (41.2)	65 (48.9)	142 (38.5)
NPV ratio (%)	72.0 ± 26.0	69.9 ± 24.7	74.3 ± 23.8	−1.807	0.071
Treatment way				10.436	0.001
FUAS alone (%)	253 (50.4)	83 (61.5)	170 (40.9)
FUAS + GnRH-a/Mirena (%)	249 (49.6)	50 (38.5)	199(59.1)

BMI: body mass index; FUAS: focused ultrasound ablation surgery; distance: from the posterior surface of the adenomyosis lesion to the sacrum; CA125: cancer antigen 125; NPV: nonperfused volume ratio; GnRH-a: gonadotrophin-releasing hormone agonist.

Table 2. Binary logistic regression analysis of symptom recurrence in patients with adenomyosis.

		Univariate			Multivariate
Varies	OR	95%CI	P	OR	95%CI	P
Age (years)	0.934	(0.900～0.970)	<0.001	0.947	(0.907～0.988)	0.012
Preoperative CA125 (U/ml)	1.003	(1.001～1.005)	0.003	1.002	(1.000～1.004)	0.043
Preoperative dysmenorrhea (yes vs no)	2.474	(1.432～4.272)	0.001	2.167	(1.168～4.021)	0.014
Hyperintensity on T2WI (yes vs no)	1.090	(0.667～1.78)	0.731	0.965	(0.553～1.685)	0.901
Grayscale change (massive vs. uniform)	0.662	(0.444～0.987)	0.043	0.601	(0.383～0.944)	0.027
FUAS combined treatment with GnRH-a/Mirena (yes vs. no)	0.515	(0.343～0.773)	0.001	0.491	(0.312～0.772)	0.002

FUAS: focused ultrasound ablation surgery; CA125: cancer antigen 125; GnRH-a: gonadotrophin-releasing hormone agonist.

Figure 2. Magnitude of serum CA125 for predicting symptom recurrence. K-M curve showed when serum CA125 level﹥35 U/ml, adenomyotic patients were more likely to relapse, medium recurrence time was 38.5 month vs. 44.5 month (P < 0.05).

Table 3. Coefficient of multivariable regression model of preoperative CA125.

	Non-standardized coefficients		Standardized coefficients	t	P	Collinearity Statistics
Model	B	SE	Beta			Tolerance	VIF
Constant	163.971	44.667		3.671	<0.001
Age (years)	−3.359	0.942	−0.161	−3.568	<0.001	0.955	1.047
Preoperative dysmenorrhea	11.356	11.127	0.046	1.021	0.308	0.944	1.060
Type of adenomyosis (diffuse vs. focus)	16.090	10.091	0.073	1.595	0.112	0.932	1.073
Uterus volume (cm^3)	0.125	0.047	0.141	2.634	0.009	0.675	1.482
Adenomyotic lesions volume (cm^3)	0.486	0.102	0.256	4.777	<0.001	0.676	1.479

CA125: cancer antigen 125.