Timchenko MA, Kuznetsova TA, Morozova TI, Nikolaeva MG. Predicting recurrence of uterine myoma after carrying out a selective uterine arteries embolization. Gynecology. 2022;24(2):95–100.
DOI: 10.26442/20795696.2022.2.201279
Прогнозирование рецидива миомы матки после проведения селективной эмболизации маточных артерий
Timchenko MA, Kuznetsova TA, Morozova TI, Nikolaeva MG. Predicting recurrence of uterine myoma after carrying out a selective uterine arteries embolization. Gynecology. 2022;24(2):95–100.
DOI: 10.26442/20795696.2022.2.201279
Цель. Установить клинико-анамнестические предикторы рецидива роста миоматозных узлов после проведения селективной эмболизации маточных артерий (с-ЭМА). Материалы и методы. Проведено одноцентровое лонгитюдное ретроспективное когортное исследование, включившее 366 женщин с симптомной миомой матки после проведения с-ЭМА, за период 2013–2017 гг. Контрольная группа – 315 пациенток после проведения с-ЭМА с полной редукцией кровотока и стойкой ремиссией в течение 3 лет. Основная группа – 51 наблюдение в случае восстановления клинических симптомов и кровотока после зарегистрированной по данным ультразвукового исследования полной редукции и купирования клинической симптоматики в период более 2 лет. Медиана возраста пациенток контрольной группы составила 40 лет (95% доверительный интервал – 95% ДИ 39,0–41,1), основной – 42 года (95% ДИ 39,0–43,0). В группах сравнения проведен анализ
103 потенциальных факторов риска рецидива миомы матки после проведения с-ЭМА. Для анализа взаимосвязи между рецидивом роста миомы матки и подмножеством количественных и качественных признаков использовалась модель логистической регрессии с пошаговым выбыванием признака. Результаты. Установлены статистически значимые факторы риска рецидива миомы матки после проведения с-ЭМА: индекс массы тела (ИМТ) <22,3 (отношение шансов – ОШ 4,03), предшествующие обильные менструальные кровотечения (ОШ 3,56), предшествующая гормональная терапия (ОШ 3,06), гипертоническая болезнь (ОШ 2,58), хронический цистит (ОШ 2,18), диспареуния (ОШ 2,22), конгломерат, включающий 2–3 миоматозных узла (ОШ 1,79), локализация миоматозного узла на ребре матки (ОШ 2,24). Использование логит-модели с включением указанных признаков позволяет прогнозировать рецидив роста миомы матки после проведения с-ЭМА в 78,8% случаев (95% ДИ 0,76–0,83; р<0,0001). Заключение. Установление на этапе предоперационного консультирования пациенток с симптомной миомой матки сочетания ИМТ<22,3, предшествующих обильных менструальных кровотечений и предшествующей гормональной терапии предполагает отказ от проведения с-ЭМА в пользу альтернативного метода лечения.
Aim. To establish clinic and anamnestic predictors for recurrence of uterine myomas growth after carrying out a selective uterine arteries embolization (s-UAE). Materials and methods. The one-center longitudinal retrospective cohort study including 366 women with symptomatic uterine myoma, after carrying out s-UAE at 2013–2017. The Control group – 315 patients after s-UAE with absolute reduction of blood-circulation and strong remission for 3 years. The main group – 51 cases of restoration of clinical symptoms and blood-groove after ultrasonography registered absolute reduction and knocking over of clinical symptoms more than two years period. The median of age of control group patients has made 40 years (95% confidence interval – 95% CI 39.0–41.1), the main – 42 years (95% CI 39.0–43.0). In group of comparison it is carried out the analysis of 103 potential risk factors for uterine myomas relapse after s-EMA. For the correlation between uterine myomas relapse and subset quantitative and qualitative signs the model of the logistic regressions was used with a step-by-step elimination of a sign. Results. Statistically significant risk factors for recurrence of uterine myomas after s-EMA are established: body mass index (BMI) <22,3 (odds ratio – OR 4.03); previous plentiful menstrual bleedings (OR 3.56); the previous hormonal therapy (OR 3.06); hypertension (OR 2.58); chronic cystitis (OR 2.18); dyspareunia (OR 2.22); the conglomerate including 2–3 uterine myomas (OR 1.79); an edge localization of uterine myomas (OR 2.24). Use a logit-models, with inclusion of these specific signs allows to predict uterine myomas growth recurrence after s-EMA in 78.8% cases (95% Cl 0.76–0.83; р<0.0001). Conclusion. At preoperative consultation stage to patients with symptomatic uterine myoma establishment a combination of criteria "body mass index" (BMI)<22.3, previous plentiful menstrual bleedings and previous hormonal therapy, assumes to refuse carrying out s-EMA in advantage alternative method of treatment.
1. Segars JH, Parrott EC, Nagel JD, et al. Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Hum Reprod Update. 2014;20:309-33.
2. McKinnon W, Middleton LJ, Cheed V, et al. FEMME Collaborative Group. Uterine-Artery Embolization or Myomectomy for Uterine Fibroids. N Engl J Med. 2020;383(5):440-51. DOI:10.1056/NEJMoa1914735
3. Адамян Л.В., Андреева Е.Н., Артымук Н.В., и др. Миома матки: диагностика, лечение и реабилитация. Проблемы репродукции. 2018;24(S6):605-49 [Adamjan LV, Andreeva EN, Artymuk NV, et al. Mioma matki: diagnostika, lechenie i reabilitacija. Problemy reprodukcii. 2018;24(S6):605-49 (in Russian)].
4. Davis MR, Soliman AM, Castelli-Haley J, et al. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Women’s Health. 2018;27(10):1204-14. DOI:10.1089/jwh.2017.6752
5. Ming X, Ran XT, Li N, et al. Risk of recurrence of uterine leiomyomas following laparoscopic myomectomy compared with open myomectomy. Arch Gynecol Obstet. 2020;301(1):235-42. DOI:10.1007/s00404-019-05399-z
6. Tang Y, Chen C, Duan H, et al. Low vascularity predicts favourable outcomes in leiomyoma patients treated with uterine artery embolization. Eur Radiol. 2016;26(10):3571-9. DOI:10.1007/s00330-016-4223-8
7. Commandeur AE, Styer AK, Teixeira JM. Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth. Hum Reprod Update. 2015;21(5):593-615.
8. Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: from menarche to menopause. Clin Obstet Gynecol. 2016;59(1):2-24.
9. Styer AK, Rueda BR. The epidemiology and genetics of uterine leiomyoma. Best Pract Res Clin Obstet Gynaecol. 2016;34:3-12.
10. Siskin GP, Beck A, Schuster M, et al. Leiomyoma infarction after uterine artery embolization: a prospective randomized study comparing tris-acryl gelatin microspheres versus polyvinyl alcohol microspheres. J Vasc Interv Radiol. 2008;19(1):58-65. DOI:10.1016/j.jvir.2007.08.034
11. Кочетов А.Г., Лянг О.В., Масенко В.П., и др. Методы статистической обработки медицинских данных. Методические рекомендации для ординаторов и аспирантов медицинских учебных заведений, научных работников. М.: РКНПК, 2012 [Kochetov AG, Ljang OV, Masenko VP, et al. Metody statisticheskoj obrabotki medicinskih dannyh. Metodicheskie rekomendacii dlja ordinatorov i aspirantov medicinskih uchebnyh zavedenij, nauchnyh rabotnikov. Moscow: RKNPK, 2012 (in Russian)].
12. Чурносов М.И., Пономаренко И.В., Полоников А.В. Патент РФ №RU 2677866 «Способ прогнозирования риска развития сочетания миомы матки и аденомиоза с использованием генетических данных» [Churnosov MI, Ponomarenko IV, Polonikov AV. Patent RF №RU 2677866 "Sposob prognozirovanija riska razvitija sochetanija miomy matki i adenomioza s ispol'zovaniem geneticheskih dannyh" (in Russian)].
13. Chuang TD, Khorram O. Cross-talk between miR-29c and transforming growth factor-β3 is mediated by an epigenetic mechanism in leiomyoma. Fertil Steril. 2019;112(6):1180-9. DOI:10.1016/j.fertnstert.2019.07.1324
14. Gracia M, Carmona F. Uterine myomas: clinical impact and pathophysiological bases. Eur J Obstet Gynecol Reprod Biol. 2020. DOI:10.1016/j.ejogrb.2020.01.043
15. Aly JM, Lewis TD, Parikh T, et al. NAV3, a Tumor Suppressor Gene, Is Decreased in Uterine Leiomyoma Tissue and Cells. Reprod Sci. 2020;27(3):925-34.
DOI:10.1007/s43032-019-00096-3
16. Khan KN, Fujishita A, Koshiba A, et al. Expression profiles of E/P receptors and fibrosis in GnRHa-treated and -untreated women with different uterine leiomyomas. PLoS One. 2020;15(11):e0242246. DOI:10.1371/journal.pone.0242246
17. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501-12. DOI:10.1111/1471-0528.14640
18. Chung YJ, Kang SY, Chun HJ, et al. Development of a Model for the Prediction of Treatment Response of Uterine Leiomyomas after Uterine Artery Embolization. Int J Med Sci. 2018;15(14):1771-7. DOI:10.7150/ijms.28687
19. Davis MR, Soliman AM, Castelli-Haley J, et al. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Women’s Heal. 2018;27(10):1204-14. DOI:10.1089/jwh.2017.6752
20. Eulálio Filho WMN, Soares EAS, Lima MSO, et al. Evaluation of KI-67 expression in uterine leiomyoma and in healthy myometrium: a pilot study. Rev Assoc Med Bras. 2019;65(12):1459-63. DOI:10.1590/1806-9282.65.12.1459
21. Khan KN, Fujishita A, Koshiba A, et al. Expression profiles of E/P receptors and fibrosis in GnRHa-treated and -untreated women with different uterine leiomyomas. PLoS One. 2020;15(11):e0242246. DOI:10.1371/journal.pone.0242246
22. Lewis TD, Malik M, Britten J, et al. A Comprehensive Review of the Pharmacologic Management of Uterine Leiomyoma. Biomed Res Int. 2018;2018:2414609. DOI:10.1155/2018/2414609
________________________________________________
1. Segars JH, Parrott EC, Nagel JD, et al. Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Hum Reprod Update. 2014;20:309-33.
2. McKinnon W, Middleton LJ, Cheed V, et al. FEMME Collaborative Group. Uterine-Artery Embolization or Myomectomy for Uterine Fibroids. N Engl J Med. 2020;383(5):440-51. DOI:10.1056/NEJMoa1914735
3. Adamjan LV, Andreeva EN, Artymuk NV, et al. Mioma matki: diagnostika, lechenie i reabilitacija. Problemy reprodukcii. 2018;24(S6):605-49 (in Russian).
4. Davis MR, Soliman AM, Castelli-Haley J, et al. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Women’s Health. 2018;27(10):1204-14. DOI:10.1089/jwh.2017.6752
5. Ming X, Ran XT, Li N, et al. Risk of recurrence of uterine leiomyomas following laparoscopic myomectomy compared with open myomectomy. Arch Gynecol Obstet. 2020;301(1):235-42. DOI:10.1007/s00404-019-05399-z
6. Tang Y, Chen C, Duan H, et al. Low vascularity predicts favourable outcomes in leiomyoma patients treated with uterine artery embolization. Eur Radiol. 2016;26(10):3571-9. DOI:10.1007/s00330-016-4223-8
7. Commandeur AE, Styer AK, Teixeira JM. Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth. Hum Reprod Update. 2015;21(5):593-615.
8. Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: from menarche to menopause. Clin Obstet Gynecol. 2016;59(1):2-24.
9. Styer AK, Rueda BR. The epidemiology and genetics of uterine leiomyoma. Best Pract Res Clin Obstet Gynaecol. 2016;34:3-12.
10. Siskin GP, Beck A, Schuster M, et al. Leiomyoma infarction after uterine artery embolization: a prospective randomized study comparing tris-acryl gelatin microspheres versus polyvinyl alcohol microspheres. J Vasc Interv Radiol. 2008;19(1):58-65. DOI:10.1016/j.jvir.2007.08.034
11. Kochetov AG, Ljang OV, Masenko VP, et al. Metody statisticheskoj obrabotki medicinskih dannyh. Metodicheskie rekomendacii dlja ordinatorov i aspirantov medicinskih uchebnyh zavedenij, nauchnyh rabotnikov. Moscow: RKNPK, 2012 (in Russian).
12. Churnosov MI, Ponomarenko IV, Polonikov AV. Patent RF №RU 2677866 "Sposob prognozirovanija riska razvitija sochetanija miomy matki i adenomioza s ispol'zovaniem geneticheskih dannyh" (in Russian).
13. Chuang TD, Khorram O. Cross-talk between miR-29c and transforming growth factor-β3 is mediated by an epigenetic mechanism in leiomyoma. Fertil Steril. 2019;112(6):1180-9. DOI:10.1016/j.fertnstert.2019.07.1324
14. Gracia M, Carmona F. Uterine myomas: clinical impact and pathophysiological bases. Eur J Obstet Gynecol Reprod Biol. 2020. DOI:10.1016/j.ejogrb.2020.01.043
15. Aly JM, Lewis TD, Parikh T, et al. NAV3, a Tumor Suppressor Gene, Is Decreased in Uterine Leiomyoma Tissue and Cells. Reprod Sci. 2020;27(3):925-34.
DOI:10.1007/s43032-019-00096-3
16. Khan KN, Fujishita A, Koshiba A, et al. Expression profiles of E/P receptors and fibrosis in GnRHa-treated and -untreated women with different uterine leiomyomas. PLoS One. 2020;15(11):e0242246. DOI:10.1371/journal.pone.0242246
17. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501-12. DOI:10.1111/1471-0528.14640
18. Chung YJ, Kang SY, Chun HJ, et al. Development of a Model for the Prediction of Treatment Response of Uterine Leiomyomas after Uterine Artery Embolization. Int J Med Sci. 2018;15(14):1771-7. DOI:10.7150/ijms.28687
19. Davis MR, Soliman AM, Castelli-Haley J, et al. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Women’s Heal. 2018;27(10):1204-14. DOI:10.1089/jwh.2017.6752
20. Eulálio Filho WMN, Soares EAS, Lima MSO, et al. Evaluation of KI-67 expression in uterine leiomyoma and in healthy myometrium: a pilot study. Rev Assoc Med Bras. 2019;65(12):1459-63. DOI:10.1590/1806-9282.65.12.1459
21. Khan KN, Fujishita A, Koshiba A, et al. Expression profiles of E/P receptors and fibrosis in GnRHa-treated and -untreated women with different uterine leiomyomas. PLoS One. 2020;15(11):e0242246. DOI:10.1371/journal.pone.0242246
22. Lewis TD, Malik M, Britten J, et al. A Comprehensive Review of the Pharmacologic Management of Uterine Leiomyoma. Biomed Res Int. 2018;2018:2414609. DOI:10.1155/2018/2414609
1 ЧУЗ «Клиническая больница “РЖД Медицина”», Барнаул, Россия;
2 ФГБОУ ВО «Алтайский государственный медицинский университет» Минздрава России, Барнаул, Россия;
3 Алтайский филиал ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России, Барнаул, Россия
*timsch@yandex.ru
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Marina A. Timchenko*1, Tatiana A. Kuznetsova2, Tatyana I. Morozova2, Mariya G. Nikolaeva2,3
1 Clinical Hospital “RZD-Medicinа”, Barnaul, Russia;
2 Altai State Medical University, Barnaul, Russia;
3 Altai Branch of National Medical Research Center of Hematology, Barnaul, Russia
*timsch@yandex.ru