Recurrence after hysteroscopic myomectomy for FIGO type II submucosal myomas: a retrospective cohort study.

BACKGROUND

We aimed to investigate the influencing factors for recurrence of International Federation of Gynaecology and Obstetrics (FIGO) type II submucosal myoma with a diameter of 4-5 cm following hysteroscopic myomectomy, and to establish an individualised prediction model for the risk of postoperative 3-year recurrence.

METHODS

In this single-centre retrospective cohort study, patients undergoing hysteroscopic myomectomy between January 2017 and June 2025 were included. Recurrence-free survival was assessed using the Kaplan-Meier method. Candidate variables were initially screened using LASSO-Cox regression with 10-fold cross-validation for λ selection, followed by multivariable Cox regression. Multicollinearity among candidate predictors was assessed using variance inflation factors. A nomogram was constructed to predict 3-year recurrence risk. Model performance was evaluated by bootstrap validation, including discrimination (C-index), calibration (calibration curve and Brier score), and clinical utility (decision curve analysis).

RESULTS

A total of 120 patients were included, and 30 recurrences occurred, mainly within 24 months after surgery. Multivariate Cox analysis identified larger myoma diameter, multiple myomas, staged operation, and longer operation time as independent risk factors, whereas older age and postoperative gonadotropin-releasing hormone agonist (GnRHa)/dienogest therapy were protective factors (P < 0.05). The nomogram showed favourable discrimination, calibration, and clinical net benefit.

CONCLUSIONS

Recurrence after hysteroscopic myomectomy was associated with tumour characteristics, surgical complexity, and postoperative hormonal therapy. The nomogram showed favourable performance, with a bootstrap-corrected C-index of 0.811, a 3-year Brier score of 0.099, and clinical net benefit across threshold probabilities of approximately 0.05-0.45. This exploratory model may support individualised 3-year recurrence risk stratification and guide follow-up and adjuvant treatment planning.