Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system
Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system
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DOI：
10.1093/humrep/del230
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发表时间：
2006-10-01
影响因子：
6.1
通讯作者：
Crosignani, Pier Giorgio
中科院分区：
文献类型：
--
作者：
Vercellini, Paolo;Fedele, Luigi;Crosignani, Pier Giorgio
背景：为了评估当前的子宫内膜异位症分类对手术治疗反应的预测价值，我们研究了疾病分期、病变类型和病变部位与术后妊娠率、症状复发和疾病复发之间的关系。方法：729例子宫内膜异位症患者接受一线保守性腹腔镜手术。根据修订的美国生育协会(AFS)分类、子宫内膜异位病变的解剖特点、生育状况以及疼痛症状的类型和严重程度收集手术时年龄、疾病分期的数据。结果：轻度子宫内膜异位症222例，轻度子宫内膜异位症106例，中度子宫内膜异位症197例，重度子宫内膜异位症204例。537例不孕症患者术后3年的累积妊娠概率为47%(I期51%，II期45%，III期46%，IV期44%；log-ranking检验，X~(2)(3)=1.50，P=0.68)。中重度痛经复发的累积概率为24%(I期32%，II期24%，III期21%，IV期19%；经对数等级检验，X~2(2)(3)=6.39，P=0.094)。累积复发概率为12%(I期3%，II期11%，III期11%，IV期23%；对数检验，x~2)(3)=24.95，P=0.0001。使用Cox的多变量比例风险回归分析，未发现子宫内膜异位症分期、病变类型和病变部位与任何所考虑的研究结果之间的关联。结论：目前对子宫内膜异位症的分类对主要临床结果的预测价值不足。
BACKGROUND: To assess the predictive value of the current classification of endometriosis in terms of response to surgical treatment, we studied to what extent disease stage, lesion type and lesion site were associated with post-operative pregnancy rate, symptom recurrence and disease relapse. METHODS: A total of 729 women with endometriosis undergoing first-line conservative laparoscopic surgery were included. Data on age at surgery, disease stage according to the revised American Fertility Society (AFS) classification, anatomical characteristics of endometriotic lesions, fertility status and types and severity of pain symptoms were collected. RESULTS: Minimal endometriosis was present in 222 patients, mild in 106, moderate in 197 and severe in 204. The cumulative probability of pregnancy at 3 years from surgery in 537 infertile women was 47% (51% at stage I, 45% at stage II, 46% at stage III and 44% at stage IV; log-rank test, chi(2)(3) = 1.50, P = 0.68). The cumulative probability of moderate or severe dysmenorrhoea recurrence in 425 symptomatic subjects was 24% (32% at stage I, 24% at stage II, 21% at stage III and 19% at stage IV; log-rank test, chi(2)(3) = 6.39, P = 0.094). The cumulative probability of disease relapse was 12% (3% at stage I, 11% at stage II, 11% at stage III and 23% at stage IV; log-rank test, chi(2)(3) = 24.95, P = 0.0001). Using Cox's multivariate proportional hazards regression analysis, no association was observed between endometriosis stage or lesion type and lesion site and any of the considered study outcomes. CONCLUSIONS: The current classification of endometriosis has an inadequate predictive value with regard to the major clinical outcomes.