| Objective: To understand the current situation and characteristics of recurrence after endometrial polyp resection in a third-class hospital of Yan ’an City in recent years,analyze the related influencing factors of recurrence after endometrial polyp resection,and build a risk prediction model of recurrence after endometrial polyp resection.In order to provide clinical reference for clinicians to initially evaluate the recurrence risk after endometrial polyp resection,screen high-risk patients with possible recurrence,take timely and effective intervention measures,and reduce the readmission rate after endometrial polyp resection.Methods: In this study,patients with endometrial polyps who all underwent hysteroscopic surgery from January 1,2015 to January 1,2021,who were seen at the Affiliated Hospital of Yan’an University were selected by reviewing our hospital case browsing system.According to the exclusion and inclusion criteria,454 patients with endometrial polyps were finally identified as study subjects to collect clinical data.All patients were followed up for 24 months after surgery,and the study subjects were divided into recurrence group(N=69 cases)and non-recurrence group(N=385 cases)according to the recurrence results.We initially understood the current situation and characteristics of recurrence after endometrial polyp resection in our hospital in recent years,and analyzed the potential risk factors affecting recurrence after endometrial polyp resection by univariate logistic regression.The influential factors with statistically significant differences(P < 0.05)in the analysis results were included in the multivariate logistic regression analysis,and the Variance Inflation Factor(VIF)of each factor was calculated to exclude the indicators with serious covariance as predictors and determine the final independent risk factors.Then,we used R software to draw a nomogram for the prediction of recurrence risk after endometrial polypectomy,and used Bootstrap method for internal validation of the model,and used Receiver Operating Characteristic(ROC),calibration curve,Decision Curve Analysis(DCA)to evaluate the discrimination,calibration and clinical usefulness of the model respectively.Results:1.Among 454 patients who underwent hysteroscopic endometrial polypectomy in our hospital,69 patients recurred and 385 patients did not recur within 2 years,with a recurrence rate of approximately 15.20%(69/454).2.There was a statistically significant difference(P < 0.05)in medical records between the group with recurrent endometrial polyps after resection and the group without recurrence(12 factors were included in univariate Logistic regression analysis).The results showed that age,body mass index,hypertension,endometriosis,polycystic ovarian syndrome,benign ovarian tumor,chronic endometritis,Breast Cancer Surgery,the number of polyps,surgical methods and postoperative progesterone use may be the potential factors affecting the recurrence of endometrial polyps after resection.3.Multivariate Logistic regression analysis showed that endometriosis(OR=4.904,95%CI= 2.3301～0.320,P < 0.01),age(OR=5.305,95%CI= 2.694～10.445,P < 0.01),number of polyps(OR=2.510,95%CI= 1.395 ～ 4.517,P=0.002),body mass index(OR=1.318,95%CI= 1.182～1.471,P < 0.01),chronic endometritis(OR=2.556,95%CI=1.100 ～ 5.942,P=0.029),and postoperative progesterone use(OR=0.198,95%CI=0.083～0.473,P < 0.01)was a protective factor for recurrence of endometrial polyps after resection.The variance inflation factors of each factor were calculated as 1.065,1.326,1.010,1.022,1.061 and 1.355 respectively,indicating that there was no serious collinearity problem among the factors.4.The Nomogram model drawn based on the results of multivariate logistic regression showed that the probability of recurrence after endometrial polypectomy was50% when the sum of the factor scores reached 164,and the risk of recurrence after endometrial polypectomy increased with the increase of the sum of the factor scores.5.By drawing ROC curve to evaluate the differentiation of the model,the AUC was0.826(95%CI: 0.776 ～ 0.875),the sensitivity was 78.3%,and the specificity was 70.4%.The calibration curve showed that the recurrence probability of endometrial polyps predicted by the model was close to the observed recurrence probability of endometrial polyps after resection,and the Hosmer-Lemeshow test,X2=10.590,P=0.226,indicated that the model had a good calibration degree.The decision analysis graph shows that the model is of positive benefit for clinical application.Conclusions:1.The recurrence rate within 2 years after intrauterine polyp resection was 15.20%(69/454)from January 1,2015 to January 1,2021 in a third-grade Grade A hospital of Yan ’an City.2.Age ≥35 years,BMI,endometriosis,chronic endometritis and the number of polyps ≥3 are independent risk factors for recurrence of endometrial polypectomy.The use of postoperative progesterone is a protective factor for the recurrence of endometrial polypectomy.3.The model established in this study has good predictive efficacy and has certain reference value for doctors,which can help clinicians to preliminatively assess the risk of recurrence after endometrial polyp resection,identify high-risk patients who may relapse early,and make appropriate clinical decisions as soon as possible. |
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