TY - JOUR
T1 - Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis
T2 - The predictive value of the current classification system
AU - Vercellini, Paolo
AU - Fedele, Luigi
AU - Aimi, Giorgio
AU - De Giorgi, Olga
AU - Consonni, Dario
AU - Crosignani, Pier Giorgio
PY - 2006/10
Y1 - 2006/10
N2 - Backgound: To assess the predictive value of the current classification of endometriosis in terms of response to surgical treatment, we studied to what extent disease stage, lesion type and lesion site were associated with post-operative pregnancy rate, symptom recurrence and disease relapse. Methods: A total of 729 women with endometriosis under going first-line conservative laparoscopic surgery were included. Data on age at surgery, disease stage according to the revised American Fertility Society (AFS) classification, anatomical characteristics of endometriotic lesions, fertility status and types and severity of pain symptoms were collected. Results: Minimal endometriosis was present in 222 patients, mild in 106, moderate in 197 and severe in 204. The cumulative probability of pregnancy at 3 years from surgery in 537 infertile women was 47% (51% at stage I, 45% at stage II, 46% at stage III and 44% at stage IV; log-rank test, χ 2 3 = 1.50, P = 0.68). The cumulative probability of moderate or severe dysmenorrhoea recurrence in 425 symptomatic subjects was 24% (32% at stage I, 24% at stage II, 21% at stage III and 19% at stage IV; log-rank test, χ 2 3 = 6.39, P = 0.094). The cumulative probability of disease relapse was 12% (3% at stage I, 11% at stage II, 11% at stage III and 23% at stage IV; log-rank test, χ 2 3 = 24.95, P = 0.0001). Using Cox's multivariate proportional hazards regression analysis, no association was observed between endometriosis stage or lesion type and lesion site and any of the considered study outcomes. Conclusions: The current classification of endometriosis has an inadequate predictive value with regard to the major clinical outcomes.
AB - Backgound: To assess the predictive value of the current classification of endometriosis in terms of response to surgical treatment, we studied to what extent disease stage, lesion type and lesion site were associated with post-operative pregnancy rate, symptom recurrence and disease relapse. Methods: A total of 729 women with endometriosis under going first-line conservative laparoscopic surgery were included. Data on age at surgery, disease stage according to the revised American Fertility Society (AFS) classification, anatomical characteristics of endometriotic lesions, fertility status and types and severity of pain symptoms were collected. Results: Minimal endometriosis was present in 222 patients, mild in 106, moderate in 197 and severe in 204. The cumulative probability of pregnancy at 3 years from surgery in 537 infertile women was 47% (51% at stage I, 45% at stage II, 46% at stage III and 44% at stage IV; log-rank test, χ 2 3 = 1.50, P = 0.68). The cumulative probability of moderate or severe dysmenorrhoea recurrence in 425 symptomatic subjects was 24% (32% at stage I, 24% at stage II, 21% at stage III and 19% at stage IV; log-rank test, χ 2 3 = 6.39, P = 0.094). The cumulative probability of disease relapse was 12% (3% at stage I, 11% at stage II, 11% at stage III and 23% at stage IV; log-rank test, χ 2 3 = 24.95, P = 0.0001). Using Cox's multivariate proportional hazards regression analysis, no association was observed between endometriosis stage or lesion type and lesion site and any of the considered study outcomes. Conclusions: The current classification of endometriosis has an inadequate predictive value with regard to the major clinical outcomes.
KW - Classification
KW - Endometriosis
KW - Infertility
KW - Pelvic pain
KW - Recurrence
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U2 - 10.1093/humrep/del230
DO - 10.1093/humrep/del230
M3 - Article
C2 - 16790608
AN - SCOPUS:33749643530
VL - 21
SP - 2679
EP - 2685
JO - Human Reproduction
JF - Human Reproduction
SN - 0268-1161
IS - 10
ER -