ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
A predictive nomogram for postoperative ovarian endometrioma recurrence in patients with congenital obstructive Müllerian anomalies: A retrospective study
Xiaotong Liu
Ning Zhang
Xuyin Zhang
Keqin Hua
Jingxin Ding
Meng Xie
Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Abstract
Objective: To develop a predictive model for ovarian endometrioma (OE) recurrence in patients with congenital obstructive Müllerian anomalies (OMA) 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. Multivariable Cox regression identified recurrence predictors; a nomogram was constructed and validated via time-dependent 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% 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 multivariate analysis, independent risk factors for endometrioma recurrence, such as preoperative hematometra >5cm³ (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 demonstrated 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 demonstrated robust model performance (5-year AUC=0.864; 10-year AUC=0.800). Conclusions: This model effectively stratifies OE recurrence risk in OMA patients’ post-surgery, guiding personalized management. Early surgical intervention to relieve Müllerian duct obstruction combined with prolonged postoperative medical suppression may optimize endometrioma recurrence prevention.
Summary
Keywords
Endometrioma recurrence, long-term follow-up, Obstructive Müllerian anomalies, ovarian endometrioma, predictive model
Received
27 September 2025
Accepted
06 February 2026
Copyright
© 2026 Liu, Zhang, Zhang, Hua, Ding and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Meng Xie
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