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MRI-Based Classification Systems Combined with Serum CA125 for Predicting Symptom Recurrence After Ultrasound-Guided
Ying Tang1,2, Hua-Dong Tian1, Xiao-Mei Chen1
1Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.
Background:
The underlying mechanisms of symptom recurrence or established comprehensive predictive models have not yet elucidated. This study aimed to establish a prediction model for symptom recurrence following focused ultrasound ablation surgery (FUAS) in adenomyosis based on magnetic resonance imaging (MRI)-based classification system incorporating serum cancer antigen (CA) 125 levels.
Methods:
We conducted a retrospective cohort study of 502 adenomyosis patients, divided into recurrence (n=133) and non-recurrence (n=369) groups. Patients were stratified by MRI lesion extent: ≥2/3 uterine wall involvement (n=446) vs <2/3 (n=56). Symptom recurrence (dysmenorrhea and/or menorrhagia) was the primary outcome. Univariate and multivariate logistic regression identified predictors. Receiver operator characteristic curve analysis determined CA125 cutoffs. Kaplan-Meier curves and Cox regression assessed recurrence-free survival.
Results:
Patients with ≥2/3 involvement had higher CA125 (57.9 vs 32.1 U/mL, P<0.001). Recurrence group had higher CA125 (71.5 vs 51.14 U/mL, P<0.001). Multivariate analysis identified CA125 (OR=1.002, 95% CI: 1.001-1.004), diffuse grayscale changes (OR=0.632, 95% CI: 0.407-0.981), and combined GnRH-a/LNG-IUS therapy (OR=0.504, 95% CI: 0.323-0.785) as independent predictors. In the ≥2/3 subgroup, CA125 >35 U/mL predicted shorter recurrence-free survival (37.7 vs 43.9 months, P=0.001). The combined model (CA125 ≥35 U/mL + lesion ≥2/3) yielded an AUC of 0.580 (95% CI: 0.533-0.626).
Conclusion:
A preoperative CA125 level ≥35 U/mL combined with MRI-based lesion extent ≥2/3 uterine wall involvement may effectively identify adenomyosis patients at high risk of post-FUAS recurrence. Further prospective studies are warranted.
