Yonsei Med J.  2015 Jul;56(4):1079-1086. 10.3349/ymj.2015.56.4.1079.

The Prognostic Value of Individual Adhesion Scores from the Revised American Fertility Society Classification System for Recurrent Endometriosis

• Yun BH
• Jeon YE
• Chon SJ
• Park JH
• Seo SK
• Cho S
• Choi YS
• Lee JS
• Lee BS

• KMID: 2366351
• DOI: http://doi.org/10.3349/ymj.2015.56.4.1079

Abstract

PURPOSE
This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrence of endometriosis after conservative laparoscopy.
MATERIALS AND METHODS
As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosis at Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperative serum CA-125 levels were retrospectively analyzed to assess their prognostic values for recurrence of endometriosis.
RESULTS
Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8+/-6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovarian cysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116-7.789), p=0.029].
CONCLUSION
Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesion score was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significance in affecting recurrence in the current study.

Keyword

Endometriosis; recurrence; prognostic factor; rAFS classification; ovarian adhesion

MeSH Terms

Adolescent
Adult
Cohort Studies
Endometriosis/*classification/*surgery
Female
Fertility
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Laparoscopy/*methods
Middle Aged
Prognosis
Recurrence
Retrospective Studies
Risk Factors
*Tissue Adhesions
Treatment Outcome
United States

Figure

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  Fig. 1 Cumulative incidence of recurrent endometriosis for different ovarian adhesion score groups. (A) Patients divided into four groups. (B) Groups with a cut off level of 24.

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