Estudio retrospectivo sobre la construcción de un modelo de nomograma basado en datos clínicos para predecir la...

Intrauterine adhesions (IUAs) are a common gynecological condition that can lead to menstrual abnormalities, infertility, and recurrent pregnancy loss. Hysteroscopic adhesiolysis is the standard treatment, but recurrence rates remain high, and factors influencing recurrence are not fully understood. This study aims to develop and validate a nomogram based on clinical data for predicting the probability of recurrence in patients with IUAs following hysteroscopic adhesiolysis.

A retrospective analysis included 256 patients who underwent hysteroscopic adhesiolysis at our hospital between October 2018 and October 2020, forming the modeling group. Additionally, 128 patients undergoing the same procedure between November 2020 and September 2021 served as the validation group. Patients in both groups were divided into recurrence and non-recurrence subgroups based on whether intrauterine adhesions recurred post-surgery. Within the modeling group, multivariate logistic regression identified factors associated with recurrence, which were incorporated into a nomogram. Model performance was evaluated using ROC and calibration curves, with external validation conducted in the validation group.

In the modeling group, the recurrence rate after the separation of intrauterine adhesions was 20.31%; Multivariate logistic regression analysis showed that disease duration >12 months and 12 days, number of induced abortions >2, number of prior uterine cavity operations >1, and adhesion range ≥1/2 of the cavity were independent risk factors for the recurrence (p < 0.05); Internal validation showed good calibration according to the Hosmer-Lemeshow (H-L) test, χ ² = 6.427, p = 0.316, and the area under the ROC curve was 0.767. External validation showed similar good calibration, χ ² = 7.006, p = 0.352; the AUC was 0.779. The nomogram demonstrated high clinical utility for predicting postoperative recurrence of intrauterine adhesions across threshold probabilities of 0.02-0.89 in the modeling group and 0.02-0.92 in the validation group.

Disease duration >12 months and 12 days, more than two induced abortions, more than one preoperative intrauterine procedure, and an adhesion range ≥1/2 were identified as independent risk factors for postoperative recurrence in patients with intrauterine adhesions. The nomogram prediction model developed based on these factors provides clinicians with a simple and intuitive tool to individualize the prediction of recurrence risk after adhesiolysis.