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Analysis of related factors influencing postoperative recurrence of adenomyosis treated with HIFU

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Abstract

Objective

To analyze the efficacy of high-intensity focused ultrasound (HIFU) for adenomyosis and postoperative recurrence and its influencing factors.

Methods

Clinical and follow-up data of 308 patients with adenomyosis who were treated with HIFU in Haifu Center, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from September 2017 to January 2022 were retrospectively analyzed. The recurrence of adenomyosis and the efficacy of HIFU at 6 months after surgery were followed up. To explore factors influencing postoperative prognosis and recurrence, the following variables were analyzed: patients’ age, course of disease, gravidity and parity, size of the uterus, duration of HIFU, duration of irradiation, treatment intensity, dysmenorrhea score, time of follow-up, combined treatment of traditional Chinese medicine (TCM), western medicine adjuvant treatment, lesion location and type, and menorrhagia.

Results

Among the 308 patients, 238 (77%) were followed up from 6 to 36 months, with an average follow-up time of 15.24 ± 9.97 months. The other 70 (23%) were lost to follow-up. At 6-month after surgery, efficacy rates of dysmenorrhea and menorrhagia management were 86.7% and 89.3%, respectively. Postoperative recurrence rates were 4.8% (1–12 months), 9.0% (12–24 months), and 17.0% (24–36 months) for dysmenorrhea; and 6.3% (1–12 months), 2.4% (12–24 months), and 12.2% (24–36 months) for menorrhagia. Multivariate logistic regression analyses showed that parity (P = 0.043, OR = 1.773, 95% CI 1.018–3.087), uterine size (P = 0.019, OR = 1.004, 95% CI 1.001–1.007), combined treatment of TCM (P = 0.047, OR = 1.846, 95% CI 1.008–3.381), diffuse lesion type (P = 0.013, OR = 0.464, 95% CI 0.254–0.848) and ablation rate (P = 0.015, OR = 0.481, 95%CI 0.267–0.868) were prognostic factors (P < 0.05). Age, course of disease, gravidity, duration of HIFU, duration of irradiation, treatment intensity, preoperative dysmenorrhea score, time of follow-up, western medicine adjuvant therapy, lesion location, and preoperative menstrual volume had no effect on prognosis (P > 0.05).

Conclusion

HIFU can effectively relieve dysmenorrhea and reduce menstrual volume in patients with adenomyosis. Parity, uterine size, lesion type (diffuse), and ablation rate are risk factors for symptom recurrence after HIFU, while the combination of TCM therapy is a protective factor for relapse. We, therefore, recommend TCM in the adjuvant setting after HIFU according to patient condition.

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Acknowledgements

I would first like to thank my teammates, whose expertise was important in reviewing information. I would especially like to thank my supervisor, who formulating the research questions and methodology. Your insightful feedback pushed me to sharpen my thinking and brought my work to a higher level. Finally, I would like to thank my family for always being kind and selfless in providing me with valuable advice and help!

Funding

This study was supported by the two projects. They are Analysis of real-world-based prognostic factors of HIFU treatment AM and the role of Chinese medicine intervention (2021MS060, Sichuan Provincial Administration of Traditional Chinese Medicine), and Real-world based study on the management of chronic disease in AM patients after HIFU with integrated Chinese and Western medicine (2020KFA3006, State Key Laboratory of Ultrasound in Medicine and Engineering). The funding organization does not have any role in the design or conduct of this study. The authors have no relevant financial or non-financial interests to disclose.

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Author notes

  1. Ling-xiu Fan and Ying Zhang contributed to the work equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Department of Gynecology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, Sichuan, China

    Ling-xiu Fan, Ying Zhang, Lei-lei Yang, Xiao-li Ji, Yan Wang, Ye-fang Huang, Ling Shi & Yi Wen

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  1. Ling-xiu Fan
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Contributions

LXF: Manuscript writing, data collection and management, data analysis. YZ: Manuscript editing, data collection and management. LLY: Data collection and management. XLJ: Data collection. YW: Data collection. YFH: Data collection. LS: Data collection. YW: Manuscript editing, Data management, project development.

Corresponding author

Correspondence to Yi Wen.

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All authors disclosed no relevant relationships.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Hospital of Chengdu University of Traditional Chinese Medicine Research Ethics Committee (No.2021-KL025).

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Informed consent was obtained from all individual participants included in the study.

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Fan, Lx., Zhang, Y., Yang, Ll. et al. Analysis of related factors influencing postoperative recurrence of adenomyosis treated with HIFU. Arch Gynecol Obstet 309, 1765–1773 (2024). https://doi.org/10.1007/s00404-023-07340-x

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