Yi Zhang, Mengying Li, Jueying Li, Qian Gao, Jiu Yin, Xiaoyu Zhao, Jingjing Li, Qinghua Zhang, Jianxin Liu, Shunshi Yang
Laparoscopic combined with transvaginal ultrasound-guided microwave ablation is an effective and safe uterine-preserving treatment for AM. Preoperative uterine volume and postoperative adjuvant therapy are independent risk factors for symptomatic recurrence; CA125 levels are associated with symptomatic recurrence. While microwave ablation offers durable relief for uteri with a volume below 268 mL, those exceeding this threshold may require postoperative adjuvant therapy to optimize outcomes.
OBJECTIVES: To evaluate the long-term therapeutic efficacy of laparoscopy combined with transvaginal ultrasound-guided microwave ablation (MWA) for adenomyosis and to identify independent risk factors for postoperative symptomatic recurrence.
MATERIAL AND METHODS: This single-centre retrospective cohort study enrolled 101 patients with adenomyosis who underwent laparoscopic transvaginal ultrasound-guided MWA at the Central Hospital of Wuhan, China, with a follow-up of up to 60 months.
RESULTS: Kaplan-Meier analysis estimated cumulative symptomatic recurrence rates of 5.9%, 18.3%, 26.3%, 33.1%, 40.3%, and 43.2% at 6, 12, 24, 36, 48, and 60 months,respectively. Significant differences between the symptomatic recurrence (n = 35) and non-recurrence (n = 66) groups were observed in preoperative uterine volume, lesion type, ablation time, and postoperative adjuvant therapy use (all P < 0.05). Multivariable Cox regression (C-index = 0.809) identified three independent predictors of symptomatic recurrence: larger preoperative uterine volume (HR = 1.014; 95% CI 1.008-1.019; P < 0.001),elevated preoperative CA125 (HR = 1.003; 95% CI 1.000-1.006; P = 0.045),and postoperative adjuvant pharmacotherapy as a protective factor (HR = 0.255; 95% CI 0.077-0.842; P = 0.025). ROC analysis identified an optimal preoperative uterine volume cutoff of 268 mL (AUC = 0.814;specificity 97.0%) for stratifying symptomatic recurrence risk. CA125 showed limited standalone discriminative ability (AUC = 0.592).
CONCLUSIONS: Laparoscopic combined with transvaginal ultrasound-guided microwave ablation is an effective and safe uterine-preserving treatment for AM. Preoperative uterine volume and postoperative adjuvant therapy are independent risk factors for symptomatic recurrence; CA125 levels are associated with symptomatic recurrence. While microwave ablation offers durable relief for uteri with a volume below 268 mL, those exceeding this threshold may require postoperative adjuvant therapy to optimize outcomes.