Clinical outcomes of uterine artery embolization in different Kishi classification types of adenomyosis.

OBJECTIVE: Uterine artery embolization (UAE) is an effective minimally invasive treatment for adenomyosis (AM). This study aimed to evaluate the clinical outcomes of UAE in patients with different AM subtypes according to the Kishi classification and to investigate the predictive value of Kishi classification for treatment efficacy and long-term recurrence. METHODS: A total of 467 patients with AM who underwent UAE were retrospectively enrolled and classified into four subtypes (types I-IV) according to the Kishi classification. Baseline demographic and clinical characteristics, as well as preoperative and 3-month postoperative Symptom Severity Scale (SSS), Health-Related Quality of Life (HRQOL), and Numerical Rating Scale (NRS) scores, were collected and analyzed. Multivariable logistic regression was performed to identify factors associated with clinical response and 5-year efficacy after UAE. RESULTS: Significant differences were observed among the four Kishi subtypes in terms of age, number of miscarriages, uterine volume, hemoglobin level, serum cancer antigen 125 (CA125) level, and the presence of concomitant ovarian endometrioma (all p < 0.05). Type II patients exhibited the lowest preoperative SSS scores. At 3 months after UAE, SSS and NRS scores significantly decreased and HRQOL scores significantly improved in all subtypes. Type I patients demonstrated the lowest postoperative SSS and NRS scores and achieved significantly higher rates of dysmenorrhea relief and clinical response than patients with type II and type IV disease. Type II patients had significantly lower clinical response rates than those with types I, III and IV. Type II and III patients experienced a higher rate of 5-year recurrence following UAE than type I and type IV patients. Multivariable analysis identified Kishi classification as an independent predictor of both clinical response and 5-year efficacy after UAE. CONCLUSION: Kishi classification is an independent predictor of clinical efficacy and long-term recurrence following UAE in patients with adenomyosis. Among the four subtypes, type I is associated with the most favorable therapeutic outcomes, whereas type II carries the highest risk of recurrence. These findings suggest that Kishi classification may serve as a useful tool for patient stratification and prognostic assessment before UAE.