Risk Factors and Preoperative Prediction Model for Endometrial Lesions in Postmenopausal Patients with Benign Ovarian...

Benign ovarian tumor is a common clinical gynecological disease. Bilateral salpingo-oophorectomy is currently recommended for postmenopausal benign ovarian tumor, and whether the uterus needs to be removed simultaneously is controversial. In this study, we proposed to evaluate the risk factors for combined endometrial lesions, aiming to provide reference for the surgical scope selection of postmenopausal benign ovarian tumor patients by constructing a preoperative prediction model.

This was a single-center retrospective study of 471 postmenopausal patients with benign ovarian tumors who were hospitalized between January 2018 and December 2024. A multivariate analysis was carried out to find out independent risk factors for coexisting endometrial lesions. A preoperative prediction model was established and its performance was evaluated by receiver operating characteristic curves, calibration curves, and decision curves.

Among 471 postmenopausal benign ovarian tumor patients, 36 (7.6%) had concurrent endometrial lesions. Menarche age, endometrial thickness under ultrasound, solid tumor under ultrasound and E₂≥10pg/mL were independent risk factors for endometrial lesions in postmenopausal benign ovarian tumor patients (P<0.001, P<0.001, P=0.049, P=0.022). The preoperative prediction model was developed based on independent risk factors and demonstrated good predictive performance (AUC = 0.821). The final model showed moderate discrimination (optimism-corrected C-index = 0.809). The nomogram exhibited excellent calibration (mean absolute error = 0.017). The decision curve analysis confirmed its potential to offer substantial clinical net benefit. The model may help identify postmenopausal patients at higher risk of coexisting endometrial lesions and inform individualized surgical decision-making pending further validation.

This study identified independent risk factors for coexisting endometrial lesions and developed a preoperative prediction model that shows promise for risk stratification. The nomogram offers a non-invasive, supportive triage tool to guide individualized management for postmenopausal patients with benign ovarian tumors.