Abstract
OBJECTIVE: This study aimed to develop a predictive model for ovarian endometrioma (OE) recurrence in patients with congenital obstructive Müllerian anomalies (OMAs) undergoing surgical intervention. METHODS: This retrospective cohort study included 139 OMA patients with histologically confirmed ovarian endometrioma undergoing complete lesion excision and anatomical reconstruction between January 2013 and December 2020. A multivariable Cox regression analysis identified recurrence predictors; a nomogram was constructed and validated via time-dependent receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis. RESULTS: The mean surgical age of 139 patients was 20.70 ± 5.81 years. Over a mean follow-up of 80.8 months, 29.5% of patients experienced OE recurrence. Cumulative recurrence rates were 1.4% (24 months), 10.1% (36 months), 27.1% (60 months), and 34.4% (120 months). In a multivariate analysis, independent risk factors for endometrioma recurrence, such as preoperative hematometra >5 cm(3) (hazard ratio [HR]: 2.650, 95%CI: 1.356-5.17, p = 0.004), rASRM score >40 (HR: 3.488, 95%CI: 1.252-9.709, p = 0.017), non-postoperative pregnancy (HR: 5.329, 95%CI: 1.399-20.307, p = 0.014), and hormonal treatment ≤30 months (HR: 3.563, 95%CI: 1.707-7.439, p = 0.001), and the other essential recurrent factor, surgical age, were all included in the nomogram. The nomogram showed strong discrimination (5-year AUC = 0.862, 10-year AUC = 0.808) and calibration, with decision curve analysis confirming clinical utility across probability thresholds. Internal validation via repeated K-fold cross-validation further showed robust model performance (5-year AUC = 0.864, 10-year AUC = 0.800). CONCLUSION: This model effectively stratifies OE recurrence risk in OMA patients post-surgery, guiding personalized management. Early surgical intervention may optimize endometrioma recurrence prevention to relieve Müllerian duct obstruction combined with prolonged postoperative medical suppression.