A prognostic nomogram for assessing the risk of recurrence after laparoscopic myomectomy.

Abstract

Objective: This study aimed to identify key predictors of uterine fibroid (UF) recurrence following laparoscopic myomectomy (LM) in reproductive-age women and to construct a predictive nomogram to support individualized clinical decision-making.

Methods: This retrospective cohort study included 459 women who underwent LM. Recurrence of UFs and risk of recurrence were analyzed. Time to recurrence, defined as the interval between surgery and imaging-confirmed regrowth, was the primary time-to-event outcome. Multivariate Cox regression and Kaplan-Meier analyses identified significant predictors of recurrence, which were used to develop a predictive nomogram.

Results: Out of 459 patients, 69 experienced recurrence during a median follow-up of 15.8 months. Significant recurrence predictors included age (30-40 years, HR = 1.74, p = 0.041; 18-30 years, HR = 1.88, p = 0.047); fibroid count (≥ 3 fibroids, HR = 2.73, p = 0.001); and fibroid size (≥ 5 cm, HR = 2.84, p < 0.001). The predictive nomogram, integrating age, number, and size of UFs, showed a C-index of 0.752 and area under the curve (AUC) values for 1-, 2-, and 3-year recurrence of 0.710, 0.783, and 0.797, respectively, reflecting robust predictive performance. Calibration curves confirmed the nomogram's accuracy in aligning predicted with observed outcomes.

Conclusion: The study developed a validated nomogram for predicting recurrence in UFs patients after LM, incorporating age, number, and size of UFs to enhance clinical decision-making.