The Prognostic Value of Individual Adhesion Scores from the Revised American Fertility Society Classification System for Recurrent Endometriosis
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Purpose: This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrenceof endometriosis after conservative laparoscopy. Materials and Methods:As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosisat Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperativeserum CA-125 levels were retrospectively analyzed to assess their prognosticvalues for recurrence of endometriosis. Results: Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8±6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovariancysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116‒7.789), p=0.029]. Conclusion: Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesionscore was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significancein affecting recurrence in the current study.
Abstract
Purpose: This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrenceof endometriosis after conservative laparoscopy. Materials and Methods:As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosisat Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperativeserum CA-125 levels were retrospectively analyzed to assess their prognosticvalues for recurrence of endometriosis. Results: Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8±6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovariancysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116‒7.789), p=0.029]. Conclusion: Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesionscore was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significancein affecting recurrence in the current study.
참고문헌 (18)
- Giudice LC, "Clinical practice. Endometriosis", N Engl J Med, 362, pp.2389~2398 (2010)
- Farquhar CM, "Extracts from the “clinical evidence”. Endometriosis", BMJ, 320, pp.1449~1452 (2000)
- Fritz MA, "Clinical gynecologic endocrinology and infertility" (2011), Lippincott Williams & Wilkins
- Cheong Y, "Laparoscopic surgery for endometriosis: how often do we need to re-operate?", J Obstet Gynaecol, 28, pp.82~85 (2008)
- Liu X, "Patterns of and risk factors for recurrence in women with ovarian endometriomas", Obstet Gynecol, 109, pp.1411~1420 (2007)
- Fedele L, "Long-term follow-up after conservative surgery for rectovaginal endometriosis", Am J Obstet Gynecol, 190, pp.1020~1024 (2004)
- Kikuchi I, "Recurrence rate of endometriomas following a laparoscopic cystectomy", Acta Obstet Gynecol Scand, 85, pp.1120~1124 (2006)
- Vercellini P, "Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system", Hum Reprod, 21, pp.2679~2685 (2006)
- Vignali M, "Surgical treatment of deep endometriosis and risk of recurrence", J Minim Invasive Gynecol, 12, pp.508~513 (2005)
- "Revised American Society for Reproductive Medicine classification of endometriosis: 1996", Fertil Steril, 67, pp.817~821 (1997)
- Koga K, "Recurrence of endometrioma after laparoscopic excision and its prevention by medical management", Front Biosci (Elite Ed), 5, pp.676~683 (2013)
- Hart RJ, "Excisional surgery versus ablative surgery for ovarian endometriomata", Cochrane Database Syst Rev, pp.CD004992~ (2008)
- Fujishita A, "Influence of pelvic endometriosis and ovarian endometrioma on fertility", Gynecol Obstet Invest, 53(Suppl 1), pp.40~45 (2002)
- Cho S, "Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the diagnosis of endometriosis", Fertil Steril, 90, pp.2073~2079 (2008)
- Medl M, "Serum levels of the tumour-associated trypsin inhibitor in patients with endometriosis", Br J Obstet Gynaecol, 104, pp.78~81 (1997)
- Lee DY, "Factors associated with the laterality of recurrent endometriomas after conservative surgery", Gynecol Endocrinol, 29, pp.978~981 (2013)
- Lee DY, "Post-operative cyclic oral contraceptive use after gonadotrophin-releasing hormone agonist treatment effectively prevents endometrioma recurrence", Hum Reprod, 25, pp.3050~3054 (2010)
- Spaczynski RZ, "Diagnosis of endometriosis", Semin Reprod Med, 21, pp.193~208 (2003)