Prediction of uterine leiomyoma recurrence in women of reproductive age

Myomectomy remains the gold standard for patients wishing to preserve fertility despite a number of available treatment options for uterine leiomyoma and symptom relief, including hysterectomy, endometrial ablation, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery. However, while this procedure is a common surgical method for fibroid removal, there are some risks, including fibroid recurrence, symptom recurrence, and the subsequent need for reintervention. Despite ongoing research and advances in surgical strategies for uterine leiomyoma treatment there are currently no universally recommended therapeutic interventions that can reliably reduce recurrence rates. Objective: The aim of the study is to determine clinical and anamnestic predictors of uterine leiomyoma recurrence in women of reproductive age. Materials and Methods. The retrospective study included 225 women of reproductive age admitted for surgical treatment of uterine leiomyoma. Patients were divided into two groups: Group 1 (n=156 women) underwent their first myomectomy, and Group 2 (n=69 women) required surgical reintervention. Recurrence was defined as reappearance of uterine leiomyoma in patients who had already undergone myomectomy at baseline, or the detection of fibroid nodes during a follow-up examination 1 year after myomectomy. The IBM SPSS STATISTICS, v.26.0 for Windows (IBM Corporation, Somers, USA), Jamovi, version 1.2.27, and StatTech v.1.2.0 (registration number 2020615715) software packages were used for database creation and mathematical processing. Logistic regression was used for mathematical modelling. Results. Predictors for uterine leiomyoma recurrence after surgery are: age ≤ 42 years (OR=3.2; 95 % CI 1.16–8.87), disease duration ≥ 7 years (OR=3.27; 95 % CI 1.17–9.18), nulliparity in the anamnesis (OR=0.23; 95 % CI 0.08–0.68), overweight/obesity and lipid metabolism disorders (OR=1.33; 95 % CI 0.49–3.62), uterine leiomyoma associated with endometriosis (OR=1.23; 95 % CI 0.45–3.33). Conclusion. In the course of the study, the risk of uterine leiomyoma recurrence was calculated at the preoperative stage using a developed mathematical model that incorporates clinical and anamnestic factors. The developed model provides a personalized, algorithmic approach to the management of women of reproductive age with uterine leiomyoma (90.9 % sensitivity, 73.8 % specificity).