Endometrioza
Rokowania, prognozy i postęp choroby

Endometrioza jest przewlekłą chorobą ginekologiczną o częstości transformacji złośliwej około 1%, charakteryzującą się wysokim ryzykiem nawrotów i koniecznością długoterminowego leczenia farmakologicznego. Kluczowe czynniki prognostyczne obejmują wiek pacjentki, status menopauzalny, czas trwania choroby, niepłodność, poziom estrogenów oraz markery biochemiczne takie jak CA125, HE4 i ROMA. Modele prognostyczne, w tym algorytmy Random Forest, wykazują wysoką wartość predykcyjną (AUC 0,816–0,982), co pozwala na ocenę ryzyka nawrotów, transformacji złośliwej oraz skuteczności leczenia. W diagnostyce istotne są markery CA125 (czułość 79,3%) i NLR (czułość połączona 86,2%, AUC 0,85), a także poziom VEGF, który jest niezależnym czynnikiem ryzyka nawrotu (AUC 0,741; poziomy VEGF 689,67 ± 127,38 pg/mL u pacjentek z nawrotem vs. 547,87 ± 171,31 pg/mL u bez nawrotu).

  1. Endometrioza – Prognoza (przewidywanie wyników)
    1. Czynniki prognostyczne w endometriozie
    2. Modele predykcyjne w endometriozie
    3. Markery biochemiczne w prognozowaniu endometriozy
    4. Indeks płodności w endometriozie (EFI) jako narzędzie prognostyczne
    5. Optymalny czas leczenia w zależności od EFI
    6. Modele przewidywania sukcesu operacyjnego
    7. Płodność i endometrioza – prognoza
    8. Endometrioza po menopauzie – prognoza
    9. Wpływ endometriozy na jakość życia – prognoza długoterminowa
    10. Przyszłość diagnostyki i prognozowania endometriozy
    11. Kolejne rozdziały

Endometrioza – Prognoza (przewidywanie wyników)

Endometrioza jest przewlekłą chorobą dotykającą kobiety w wieku rozrodczym, z częstością występowania transformacji złośliwej około 1%. Prognoza dla pacjentek z endometriozą jest generalnie dobra, jednak należy pamiętać o wysokim wskaźniku nawrotów choroby i jej objawów.12 Długoterminowe leczenie farmakologiczne jest konieczne, gdyż endometrioza jest uważana za stan przewlekły. Optymalne prowadzenie pacjentek powinno odbywać się w wyspecjalizowanych klinikach i obejmować zarówno kontrolę kliniczną (wywiad lekarski i badanie fizykalne), jak i dodatkowe badania w zależności od zajętego narządu i stopnia zaawansowania choroby.3

Czynniki prognostyczne w endometriozie

Istnieje kilka kluczowych czynników prognostycznych, które mogą pomóc w przewidywaniu przebiegu endometriozy i jej potencjalnych komplikacji:

  • Wiek pacjentki – starszy wiek jest niezależnym czynnikiem ryzyka transformacji złośliwej
  • Status menopauzalny – ryzyko transformacji złośliwej może być wyższe po menopauzie
  • Długi czas trwania choroby – im dłuższy przebieg choroby, tym większe ryzyko powikłań
  • Niepłodność związana z endometriozą – stanowi czynnik ryzyka złośliwej transformacji
  • Wysoki poziom estrogenów – może zwiększać ryzyko złośliwej transformacji
  • Podwyższone markery takie jak CA125, HE4 i ROMA – stanowią czynniki ryzyka transformacji złośliwej

4

Modele predykcyjne w endometriozie

W ostatnich latach opracowano różne modele prognostyczne dla endometriozy, które mogą pomóc w ocenie stanu choroby i jej prognozie. Te modele wykorzystują różne kombinacje czynników klinicznych, laboratoryjnych i obrazowych w celu przewidywania wyników leczenia, nawrotów oraz ryzyka transformacji złośliwej.5

Siła predykcyjna różnych czynników w modelach prognostycznych (w kolejności malejącej) wygląda następująco:

6

Modele te wykazują dobrą wartość predykcyjną, z polem powierzchni pod krzywą (AUC) od 0,816 do 0,982, co wskazuje na silną zdolność prognozowania. Niektóre modele, jak model oparty na algorytmie Random Forest (RF), posiadają AUC dla walidacji wewnętrznej i zewnętrznej na poziomie 0,927 vs 0,838, co potwierdza ich dobrą moc predykcyjną.78

Markery biochemiczne w prognozowaniu endometriozy

W diagnostyce i prognozowaniu endometriozy wykorzystuje się różne markery biochemiczne, z których najważniejsze to:

  • CA125 – pozostaje kluczowym markerem w diagnostyce endometriozy
  • NLR (stosunek neutrofili do limfocytów) – może służyć jako nowy dodatkowy biomarker w połączeniu z CA125
  • VEGF (czynnik wzrostu śródbłonka naczyniowego) – wyjściowy poziom VEGF w surowicy może być przydatny w przewidywaniu nawrotu po operacji

91011

Wartość diagnostyczna CA125 w połączeniu z NLR dla endometriozy jest wyższa niż samego CA125. Czułość połączonego badania CA125 i NLR wynosi 86,2%, co jest lepszym wynikiem niż dla samego CA125 (79,3%). Krzywe ROC, czułość i swoistość CA125 i NLR potwierdzają ich przydatność w diagnostyce endometriozy jajnikowej, z wartością AUC wynoszącą 0,85.12

W przypadku markerów przewidujących nawroty, badania wskazują, że poziom VEGF w surowicy jest niezależnym czynnikiem ryzyka nawrotu endometriozy po operacji. AUC poziomu VEGF w surowicy dla przewidywania nawrotu endometriozy po operacji wynosi 0,741 (95% przedział ufności 0,594–0,887). Pacjentki z nawrotem były znacząco młodsze (25,9 ± 4,3 vs. 30,3 ± 6,0 lat, p = 0,040) i miały wyższe wyjściowe poziomy VEGF w surowicy (689,67 ± 127,38 vs. 547,87 ± 171,31 pg/mL, p = 0,023).13

Indeks płodności w endometriozie (EFI) jako narzędzie prognostyczne

Endometriosis Fertility Index (EFI) jest zwalidowanym systemem punktowym do przewidywania wskaźnika samoistnych ciąż po operacji endometriozy. Klasyfikacja American Society for Reproductive Medicine (ASRM) ma ograniczoną wartość predykcyjną dla ciąży po operacji, natomiast EFI okazuje się być wiarygodnym systemem oceny do przewidywania wyników ciąży bez technik wspomaganego rozrodu (ART) i z ich zastosowaniem po operacji endometriozy.1415

Badania wykazały, że wskaźnik ciąż był wyraźnie wyższy u pacjentek z wysokimi wynikami EFI niż u tych z niskimi wynikami. Wynik poniżej 4 był związany ze znacznie niższym wskaźnikiem ciąż niż wynik powyżej 5 (n=26, wskaźnik ciąż – 11,54%) w porównaniu do (n=51, wskaźnik ciąż 50,1%); p = 0,001).16 Skumulowana liczba ciąż bez ART w ciągu 36 miesięcy wynosiła 10% (95% CI: 3, 16; P 0,001) dla kobiet z EFI 0-2 i 69% (95% CI: 58, 79; P 0,001) dla kobiet z EFI 9-10.17

Indeks EFI jest przydatnym narzędziem klinicznym, które z rozsądną dokładnością przewiduje ciążę po operacji endometriozy. Jego zastosowanie wyraźnie daje pewność tym pacjentkom, które mają dobrą prognozę.18

Optymalny czas leczenia w zależności od EFI

Wartość indeksu EFI może być pomocna w określeniu optymalnego czasu skierowania pacjentek na techniki wspomaganego rozrodu (ART) po operacji endometriozy:

  • Pacjentki z niekorzystnym EFI (≤4) mają więcej ciąż z ART niż pacjentki z korzystnym EFI (≥5) i powinny być skierowane na ART wkrótce po operacji
  • Pacjentki z korzystnym EFI (≥5) mogą próbować zajść w ciążę spontanicznie przez 24 miesiące przed skierowaniem na ART

1920

Płodność była optymalna do 12 miesięcy po operacji u kobiet z EFI ≤4, po czym zmniejszała się. W przypadku pacjentek z EFI ≥5, płodność była stabilna do 24 miesięcy po operacji, zanim zaczęła się zmniejszać.21

Modele przewidywania sukcesu operacyjnego

Endometrioza nie ma lekarstwa, a operacja jest jedną z kilku opcji leczenia. Określenie prawdopodobieństwa sukcesu operacji jest ważne dla kierowania decyzjami klinicznymi i strategiami leczenia.22

Sukces leczenia operacyjnego może być definiowany poprzez zmiany w samoocenie bólu lub jakości życia od wartości wyjściowej do 6 miesięcy lub 1 roku po operacji. Modele predykcyjne mogą dostarczyć lekarzom narzędzie wspierające dla poprawy podejmowania decyzji w diagnostyce i leczeniu kobiet, zmniejszając tym samym niepotrzebne koszty i szkody związane z laparoskopią.23

Nie zidentyfikowano jeszcze odpowiednio czynników przewidujących sukces poprzez zmniejszenie bólu po operacji endometriozy. Prowadzone są badania mające na celu przewidywanie, kto najbardziej skorzysta z chirurgii laparoskopowej poprzez zmniejszenie bólu lub poprawę jakości życia.24

Płodność i endometrioza – prognoza

Endometrioza jest jedną z głównych przyczyn niepłodności. Powoduje rozrost tkanki w miejscach, w których nie powinna ona występować, co może zakłócać spotkanie plemnika i komórki jajowej podczas poczęcia.25

Chociaż zajście w ciążę jest możliwe, może być to bardziej wymagające w porównaniu do osób bez endometriozy. Jeśli pacjentka z endometriozą chce zajść w ciążę, powinna skonsultować się z lekarzem w celu ustalenia najlepszej opcji leczenia. Może być konieczne przeprowadzenie operacji w celu leczenia endometriozy.26

Endometrioza po menopauzie – prognoza

Rozwój endometriozy po menopauzie nie jest typowy. Jeśli występuje po menopauzie, może to być spowodowane faktem, że istniała przed menopauzą i mogła zostać reaktywowana z powodu przyjmowania hormonalnej terapii zastępczej (HTZ).27 Status menopauzalny jest niezależnym czynnikiem ryzyka transformacji złośliwej endometriozy. Nawet jeśli objawy kliniczne związane z endometriozą znikają po menopauzie, ryzyko transformacji złośliwej nadal istnieje i może być nawet wyższe.28

Wpływ endometriozy na jakość życia – prognoza długoterminowa

Endometrioza może wpływać na życie kobiety na wiele sposobów – zarówno fizycznie, jak i emocjonalnie. Chociaż objawy mogą być bardziej dotkliwe dla jednych i łagodniejsze dla innych, choroba nieuchronnie stwarza wyzwania.29 Endometrioza wiąże się z długoterminowym wzrostem kosztów opieki zdrowotnej z powodu konieczności regularnych kontroli i leczenia.30

Przyszłość diagnostyki i prognozowania endometriozy

Obecnie zastosowanie uczenia maszynowego w diagnostyce endometriozy pozostaje w fazie wstępnych badań. Chociaż poczyniono pewne postępy w budowaniu modeli diagnostycznych, ich dokładność wymaga dalszej walidacji.31

Na tym etapie poleganie wyłącznie na modelach uczenia maszynowego do diagnostyki endometriozy jest niepraktyczne. Jednak wykorzystanie tych modeli do samotestowania pacjentów i wstępnej selekcji jest wykonalne i prawdopodobnie stanie się przedmiotem przyszłych badań.32

Opracowanie i walidacja odpowiednich czynników predykcyjnych ma ogromne znaczenie dla zapobiegania i leczenia endometriozy. Duża liczba badań ustanowiła i zwalidowała odpowiednie modele predykcyjne do oceny stanu i prognozy endometriozy. Te modele mogą w przyszłości umożliwić opracowanie standaryzowanych strategii długoterminowego zarządzania grupami wysokiego ryzyka.33

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Prognosis for endometriosis | PortalCLÍNIC
    https://www.clinicbarcelona.org/en/assistance/diseases/endometriosis/evolution-of-the-disease
    The prognosis for patients with endometriosis is generally good. […] It is important to bear in mind the high rate of recurrence of the disease and its symptoms, and that the concomitant medical treatment takes a long-term perspective as it is considered a chronic condition. […] Follow-up should preferably be carried out in specialised clinics and must include clinical control (history taking and physical examination) as well as additional testing in function of which organ is affected and to what degree. […] Endometriosis is associated with a long-term increase in healthcare costs.
  • #2
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    Endometriosis is a common benign disease in women of childbearing age, with a malignant change rate of about 1%. […] Early identification of high-risk groups of EMs malignant transformation is of great significance for the prevention and treatment of EAOC. […] However, there is still a lack of specific and sensitive prediction factors. […] A large number of studies have established and validated relevant prediction models to evaluate the condition and prognosis of EMs. […] The relevant prediction factors and prediction models were summarized to provide reference and new thinking for the research of prediction models in the field of EAOC, in order to develop standardized long-term management strategies for high-risk groups of EAOC and realize the advance of the diagnosis threshold of patients with EAOC.
  • #3 Prognosis for endometriosis | PortalCLÍNIC
    https://www.clinicbarcelona.org/en/assistance/diseases/endometriosis/evolution-of-the-disease
    The prognosis for patients with endometriosis is generally good. […] It is important to bear in mind the high rate of recurrence of the disease and its symptoms, and that the concomitant medical treatment takes a long-term perspective as it is considered a chronic condition. […] Follow-up should preferably be carried out in specialised clinics and must include clinical control (history taking and physical examination) as well as additional testing in function of which organ is affected and to what degree. […] Endometriosis is associated with a long-term increase in healthcare costs.
  • #4
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    Age is an independent risk factor for EAOC. […] Most studies believe that the older patients with EMs have a higher risk of malignant transformation, and the risk of EAOC is positively correlated with age. […] Menopausal status is an independent risk factor of EAOC. […] Even if EMs-related clinical symptoms disappear after menopause, the risk of EAOC is still present and even higher. […] The long course of disease is also one of the high risk factors of EAOC. […] Infertility associated with endometriosis is a risk factor of malignant transformation of EMs. […] High estrogen level is a risk factor for EMs malignancy, and single estrogen therapy in postmenopausal EMs patients increases the risk of malignancy. […] Increased CA125, HE4, and ROMA were risk factors of EAOC. […] The predictive factors used for model construction are the risk factors in the meta-analysis.
  • #5
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    Endometriosis is a common benign disease in women of childbearing age, with a malignant change rate of about 1%. […] Early identification of high-risk groups of EMs malignant transformation is of great significance for the prevention and treatment of EAOC. […] However, there is still a lack of specific and sensitive prediction factors. […] A large number of studies have established and validated relevant prediction models to evaluate the condition and prognosis of EMs. […] The relevant prediction factors and prediction models were summarized to provide reference and new thinking for the research of prediction models in the field of EAOC, in order to develop standardized long-term management strategies for high-risk groups of EAOC and realize the advance of the diagnosis threshold of patients with EAOC.
  • #6
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    The alignment diagram is a common clinical prediction model, and its essence is a graph of multivariable logistic regression analysis. […] The predictive power of the predictors in descending order is as follows: HE4, ROMA, solid component of the cyst, papillary of the cyst wall, blood flow signal, thickness of the cyst wall, menopausal status, maximum diameter of the cyst, age, abnormal menstruation and disease course. […] The AUC of the model is 0.982, indicating that this model has strong predictive ability. […] The Gail model can be used to estimate the 5-year or lifetime risk of breast cancer. […] The AUC of the model in the training set and validation set were 0.856 and 0.892, respectively. […] The AUC of this model is 0.816, and the critical value of EMs malignant transformation was 18.70.
  • #7
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    The alignment diagram is a common clinical prediction model, and its essence is a graph of multivariable logistic regression analysis. […] The predictive power of the predictors in descending order is as follows: HE4, ROMA, solid component of the cyst, papillary of the cyst wall, blood flow signal, thickness of the cyst wall, menopausal status, maximum diameter of the cyst, age, abnormal menstruation and disease course. […] The AUC of the model is 0.982, indicating that this model has strong predictive ability. […] The Gail model can be used to estimate the 5-year or lifetime risk of breast cancer. […] The AUC of the model in the training set and validation set were 0.856 and 0.892, respectively. […] The AUC of this model is 0.816, and the critical value of EMs malignant transformation was 18.70.
  • #8
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    The AUC of the model in the training set was 0.903, indicating that the model has good accuracy. […] The study also used a GBDT model to analyze patients data, and validated the model using 10-fold cross-validation, that is, dividing the training data set into 10 equal parts containing the same proportion of EAOC. […] The AUC for internal and external validation of the RF model was 0.927 vs 0.838, indicating that the model has good predictive power.
  • #9 Application of machine learning techniques in the diagnosis of endometriosis | BMC Women’s Health | Full Text
    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03334-2
    The diagnostic value of serum CA125 combined with the NLR for EM is higher than that of serum CA125 alone. This finding indicates that NLR could serve as a new supplementary biomarker along with serum CA125 in the diagnosis of EM. […] The combined prediction of CA125 and NLR was superior to the prediction using CA125 alone. […] Our data demonstrated that the combination of NLR and CA125 was more sensitive (86.2%) than CA125 alone (79.3%) in diagnosing EM. […] The ROC curves, sensitivity, and specificity of CA125 and NLR confirmed their use in diagnosing ovarian EM, with the AUC being 0.85. The combined assays significantly enhanced the detection rate of ovarian EM, achieving a sensitivity of 86.21%. Therefore, the combined detection of CA125 and NLR holds substantial value in diagnosing ovarian EM.
  • #10 Application of machine learning techniques in the diagnosis of endometriosis | BMC Women’s Health | Full Text
    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03334-2
    Despite this, serum CA125 remains a crucial marker in the diagnosis of EM. […] However, the findings in this area are not yet consistent. […] Currently, the application of machine learning in EM remains in the preliminary exploration stage. While some progress has been made in constructing diagnostic models, their accuracy requires further validation. […] At this stage, it is impractical to rely solely on machine learning models for the diagnosis of EM. However, using these models for patient self-testing and pre-screening triage is feasible and likely to become a focus of future research.
  • #11 Predictive Value of Serum Vascular Endothelial Growth Factor Level for Postoperative Endometriosis Recurrence in Patients with Ovarian Endometriosis
    https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009187/htm
    Baseline serum VEGF level is an independent risk factor of postoperative endometriosis recurrence and might be useful for predicting endometriosis recurrence. […] The AUC of serum VEGF levels for predicting postoperative endometriosis recurrence was 0.741 (95% confidence interval 0.594–0.887). […] Compared with patients without recurrence, patients with recurrence were significantly younger (25.9 ± 4.3 vs. 30.3 ± 6.0 years, p = 0.040) and had higher baseline serum VEGF levels (689.67 ± 127.38 vs. 547.87 ± 171.31 pg/mL, p = 0.023), but there was no difference in other baseline characteristics.
  • #12 Application of machine learning techniques in the diagnosis of endometriosis | BMC Women’s Health | Full Text
    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03334-2
    The diagnostic value of serum CA125 combined with the NLR for EM is higher than that of serum CA125 alone. This finding indicates that NLR could serve as a new supplementary biomarker along with serum CA125 in the diagnosis of EM. […] The combined prediction of CA125 and NLR was superior to the prediction using CA125 alone. […] Our data demonstrated that the combination of NLR and CA125 was more sensitive (86.2%) than CA125 alone (79.3%) in diagnosing EM. […] The ROC curves, sensitivity, and specificity of CA125 and NLR confirmed their use in diagnosing ovarian EM, with the AUC being 0.85. The combined assays significantly enhanced the detection rate of ovarian EM, achieving a sensitivity of 86.21%. Therefore, the combined detection of CA125 and NLR holds substantial value in diagnosing ovarian EM.
  • #13 Predictive Value of Serum Vascular Endothelial Growth Factor Level for Postoperative Endometriosis Recurrence in Patients with Ovarian Endometriosis
    https://www.imrpress.com/journal/CEOG/50/9/10.31083/j.ceog5009187/htm
    Baseline serum VEGF level is an independent risk factor of postoperative endometriosis recurrence and might be useful for predicting endometriosis recurrence. […] The AUC of serum VEGF levels for predicting postoperative endometriosis recurrence was 0.741 (95% confidence interval 0.594–0.887). […] Compared with patients without recurrence, patients with recurrence were significantly younger (25.9 ± 4.3 vs. 30.3 ± 6.0 years, p = 0.040) and had higher baseline serum VEGF levels (689.67 ± 127.38 vs. 547.87 ± 171.31 pg/mL, p = 0.023), but there was no difference in other baseline characteristics.
  • #14 External validation of the endometriosis fertility index (EFI) for predicting spontaneous pregnancy after surgery: further considerations on its validity – PubMed
    https://pubmed.ncbi.nlm.nih.gov/25634444/
    The revised American Society for Reproductive Medicine classification of endometriosis has a limited predictive value for pregnancy after surgery. […] This study aimed to (i) provide an external validation of the EFI score in predicting pregnancy in infertile Italian endometriosis women; (ii) evaluate the predictive value of EFI score on ART outcome for patients who previously attempted to spontaneously conceive after surgery. […] Differences in time to non-ART pregnancy for the six EFI groups were statistically significant (log-rank, p = 1.4 10(-4)). […] The area under the curve (AUC) for EFI as ART outcome predictor was 0.75 (95% CI 0.61-0.89, p = 6.2 10(-3)), while the best cut-point for pregnancy was 5.5. […] The EFI score is a reliable scoring system to predict non-ART and ART pregnancy outcome after surgery for endometriosis.
  • #15 Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame? | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251372
    The Endometriosis Fertility Index (EFI) is a validated score for predicting the postoperative spontaneous pregnancy rate in patients undergoing endometriosis surgery. […] The EFI was developed to predict the spontaneous pregnancy rate in women 3 years after surgery for endometriosis. […] The rate of spontaneous pregnancies is greater in women with higher EFI scores; cumulative non-ART pregnancy at 36 months was found to be 10% (95%CI: 3, 16; P 0.001) for women with an EFI of 02, and 69% (95%CI: 58, 79; P 0.001) for women with an EFI of 910. […] Our analysis suggests that patients with an unfavorable EFI (4) have more ART pregnancies than patients with a favorable EFI (5) and should be referred for ART shortly after surgery. Patients with a favorable EFI may attempt spontaneous pregnancy for 24 months before referral.
  • #16
    https://www.ijrcog.org/index.php/ijrcog/article/view/6550
    Endometriosis still remains an enigmatic disease. There are important reasons to stage endometriosis and to prognosticate the chances of pregnancy after a surgical management. A scoring system-Endometriosis fertility index (EFI) to prognosticate the outcome was proposed few years back. The objective was to assess the usefulness of the EFI system in predicting pregnancy in patients with surgically documented endometriosis who attempt Non-IVF conception. […] Our study showed that the pregnancy rate was clearly higher in those with high EFI scores than those with low scores. A score of less than 4 was associated with significantly lower pregnancy rates than those with score above 5 (n=26, pregnancy rate- 11.54%) vs. (n=51, pregnancy rate 50.1%); p = 0.001)). […] EFI is a useful clinical tool that predicts pregnancy with reasonable accuracy after endometriosis surgery. Its use clearly provides reassurance to those patients with good prognosis.
  • #17 Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame? | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251372
    The Endometriosis Fertility Index (EFI) is a validated score for predicting the postoperative spontaneous pregnancy rate in patients undergoing endometriosis surgery. […] The EFI was developed to predict the spontaneous pregnancy rate in women 3 years after surgery for endometriosis. […] The rate of spontaneous pregnancies is greater in women with higher EFI scores; cumulative non-ART pregnancy at 36 months was found to be 10% (95%CI: 3, 16; P 0.001) for women with an EFI of 02, and 69% (95%CI: 58, 79; P 0.001) for women with an EFI of 910. […] Our analysis suggests that patients with an unfavorable EFI (4) have more ART pregnancies than patients with a favorable EFI (5) and should be referred for ART shortly after surgery. Patients with a favorable EFI may attempt spontaneous pregnancy for 24 months before referral.
  • #18
    https://www.ijrcog.org/index.php/ijrcog/article/view/6550
    Endometriosis still remains an enigmatic disease. There are important reasons to stage endometriosis and to prognosticate the chances of pregnancy after a surgical management. A scoring system-Endometriosis fertility index (EFI) to prognosticate the outcome was proposed few years back. The objective was to assess the usefulness of the EFI system in predicting pregnancy in patients with surgically documented endometriosis who attempt Non-IVF conception. […] Our study showed that the pregnancy rate was clearly higher in those with high EFI scores than those with low scores. A score of less than 4 was associated with significantly lower pregnancy rates than those with score above 5 (n=26, pregnancy rate- 11.54%) vs. (n=51, pregnancy rate 50.1%); p = 0.001)). […] EFI is a useful clinical tool that predicts pregnancy with reasonable accuracy after endometriosis surgery. Its use clearly provides reassurance to those patients with good prognosis.
  • #19 Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame? | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251372
    The Endometriosis Fertility Index (EFI) is a validated score for predicting the postoperative spontaneous pregnancy rate in patients undergoing endometriosis surgery. […] The EFI was developed to predict the spontaneous pregnancy rate in women 3 years after surgery for endometriosis. […] The rate of spontaneous pregnancies is greater in women with higher EFI scores; cumulative non-ART pregnancy at 36 months was found to be 10% (95%CI: 3, 16; P 0.001) for women with an EFI of 02, and 69% (95%CI: 58, 79; P 0.001) for women with an EFI of 910. […] Our analysis suggests that patients with an unfavorable EFI (4) have more ART pregnancies than patients with a favorable EFI (5) and should be referred for ART shortly after surgery. Patients with a favorable EFI may attempt spontaneous pregnancy for 24 months before referral.
  • #20 Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame? | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251372
    The objective of the present study was therefore to assess the value of the EFI in deciding the optimal time to refer patients for ART after surgery for endometriosis. […] We observed more ART pregnancies in patients with an EFI of 04. Patients with a favorable EFI (5) had more natural pregnancies than patients with an unfavorable EFI (4). […] Fecundability was optimal up to 12 months postoperatively in women with an EFI 4, after which it decreased. For patients with an EFI 5, fecundability was stable up to 24 months postoperatively before decreasing. […] Our study suggests that the optimal time frame to manage postoperative infertility varies according to the EFI: patients with a favorable EFI (5) may be allowed to have 24 months of spontaneous attempts to conceive whereas patients with an unfavorable EFI (4) should be more rapidly referred for ART.
  • #21 Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame? | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251372
    The objective of the present study was therefore to assess the value of the EFI in deciding the optimal time to refer patients for ART after surgery for endometriosis. […] We observed more ART pregnancies in patients with an EFI of 04. Patients with a favorable EFI (5) had more natural pregnancies than patients with an unfavorable EFI (4). […] Fecundability was optimal up to 12 months postoperatively in women with an EFI 4, after which it decreased. For patients with an EFI 5, fecundability was stable up to 24 months postoperatively before decreasing. […] Our study suggests that the optimal time frame to manage postoperative infertility varies according to the EFI: patients with a favorable EFI (5) may be allowed to have 24 months of spontaneous attempts to conceive whereas patients with an unfavorable EFI (4) should be more rapidly referred for ART.
  • #22 JMIR Research Protocols – Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study
    https://www.researchprotocols.org/2021/4/e20986/
    Endometriosis has no cure. Surgery is one of several management options. Quantifying the probability of successful surgery is important for guiding clinical decisions and treatment strategies. […] Factors predicting success through pain reduction after endometriosis surgery have not yet been adequately identified. […] This study is the first to aim to predict who will benefit most from laparoscopic surgery through the reduction of pain or increased QoL. The models will provide clinicians with robustly developed and externally validated support tools, improving decision making in the diagnosis and treatment of women. […] Quantifying the potential for improvement in a woman’s symptoms after surgery is important for guiding clinical decisions and treatment strategies. […] Our aim is to address the existing gap by predicting success through pain reduction after endometriosis surgery.
  • #23 JMIR Research Protocols – Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study
    https://www.researchprotocols.org/2021/4/e20986/
    Treatment success will be defined by changes in self-reported pain scores or QoL from baseline to 6 months or 1 year after surgery. […] The prediction models will provide clinicians with a supporting tool for improving decision making in the diagnosis and treatment of women, thereby reducing unnecessary costs and harms associated with laparoscopic surgery.
  • #24 JMIR Research Protocols – Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study
    https://www.researchprotocols.org/2021/4/e20986/
    Endometriosis has no cure. Surgery is one of several management options. Quantifying the probability of successful surgery is important for guiding clinical decisions and treatment strategies. […] Factors predicting success through pain reduction after endometriosis surgery have not yet been adequately identified. […] This study is the first to aim to predict who will benefit most from laparoscopic surgery through the reduction of pain or increased QoL. The models will provide clinicians with robustly developed and externally validated support tools, improving decision making in the diagnosis and treatment of women. […] Quantifying the potential for improvement in a woman’s symptoms after surgery is important for guiding clinical decisions and treatment strategies. […] Our aim is to address the existing gap by predicting success through pain reduction after endometriosis surgery.
  • #25 Endometriosis: Causes, Symptoms, Diagnosis & Treatment
    https://my.clevelandclinic.org/health/diseases/10857-endometriosis
    Endometriosis is one of the leading causes of infertility. Endometriosis causes tissue to grow in places where it doesn’t belong. This can interfere with how a sperm and egg move to meet each other at conception. […] Endometriosis can impact your life in many ways physically and emotionally. While the symptoms can be worse for some and easier for others, the condition is bound to create challenges for you. […] Yes, you can get pregnant. But it may be more challenging for you compared to people who don’t have endometriosis. If you have endometriosis and want to get pregnant, talk to your healthcare provider about the best treatment option for you. You might need to have surgery to treat endometriosis. Your provider will work with you to find the best treatment plan to help support pregnancy. […] It isn’t typical to develop endometriosis after menopause. If you have it after menopause, it may be because you had it before menopause and it may have reactivated due to taking hormone replacement therapy (HRT).
  • #26 Endometriosis: Causes, Symptoms, Diagnosis & Treatment
    https://my.clevelandclinic.org/health/diseases/10857-endometriosis
    Endometriosis is one of the leading causes of infertility. Endometriosis causes tissue to grow in places where it doesn’t belong. This can interfere with how a sperm and egg move to meet each other at conception. […] Endometriosis can impact your life in many ways physically and emotionally. While the symptoms can be worse for some and easier for others, the condition is bound to create challenges for you. […] Yes, you can get pregnant. But it may be more challenging for you compared to people who don’t have endometriosis. If you have endometriosis and want to get pregnant, talk to your healthcare provider about the best treatment option for you. You might need to have surgery to treat endometriosis. Your provider will work with you to find the best treatment plan to help support pregnancy. […] It isn’t typical to develop endometriosis after menopause. If you have it after menopause, it may be because you had it before menopause and it may have reactivated due to taking hormone replacement therapy (HRT).
  • #27 Endometriosis: Causes, Symptoms, Diagnosis & Treatment
    https://my.clevelandclinic.org/health/diseases/10857-endometriosis
    Endometriosis is one of the leading causes of infertility. Endometriosis causes tissue to grow in places where it doesn’t belong. This can interfere with how a sperm and egg move to meet each other at conception. […] Endometriosis can impact your life in many ways physically and emotionally. While the symptoms can be worse for some and easier for others, the condition is bound to create challenges for you. […] Yes, you can get pregnant. But it may be more challenging for you compared to people who don’t have endometriosis. If you have endometriosis and want to get pregnant, talk to your healthcare provider about the best treatment option for you. You might need to have surgery to treat endometriosis. Your provider will work with you to find the best treatment plan to help support pregnancy. […] It isn’t typical to develop endometriosis after menopause. If you have it after menopause, it may be because you had it before menopause and it may have reactivated due to taking hormone replacement therapy (HRT).
  • #28
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    Age is an independent risk factor for EAOC. […] Most studies believe that the older patients with EMs have a higher risk of malignant transformation, and the risk of EAOC is positively correlated with age. […] Menopausal status is an independent risk factor of EAOC. […] Even if EMs-related clinical symptoms disappear after menopause, the risk of EAOC is still present and even higher. […] The long course of disease is also one of the high risk factors of EAOC. […] Infertility associated with endometriosis is a risk factor of malignant transformation of EMs. […] High estrogen level is a risk factor for EMs malignancy, and single estrogen therapy in postmenopausal EMs patients increases the risk of malignancy. […] Increased CA125, HE4, and ROMA were risk factors of EAOC. […] The predictive factors used for model construction are the risk factors in the meta-analysis.
  • #29 Endometriosis: Causes, Symptoms, Diagnosis & Treatment
    https://my.clevelandclinic.org/health/diseases/10857-endometriosis
    Endometriosis is one of the leading causes of infertility. Endometriosis causes tissue to grow in places where it doesn’t belong. This can interfere with how a sperm and egg move to meet each other at conception. […] Endometriosis can impact your life in many ways physically and emotionally. While the symptoms can be worse for some and easier for others, the condition is bound to create challenges for you. […] Yes, you can get pregnant. But it may be more challenging for you compared to people who don’t have endometriosis. If you have endometriosis and want to get pregnant, talk to your healthcare provider about the best treatment option for you. You might need to have surgery to treat endometriosis. Your provider will work with you to find the best treatment plan to help support pregnancy. […] It isn’t typical to develop endometriosis after menopause. If you have it after menopause, it may be because you had it before menopause and it may have reactivated due to taking hormone replacement therapy (HRT).
  • #30 Prognosis for endometriosis | PortalCLÍNIC
    https://www.clinicbarcelona.org/en/assistance/diseases/endometriosis/evolution-of-the-disease
    The prognosis for patients with endometriosis is generally good. […] It is important to bear in mind the high rate of recurrence of the disease and its symptoms, and that the concomitant medical treatment takes a long-term perspective as it is considered a chronic condition. […] Follow-up should preferably be carried out in specialised clinics and must include clinical control (history taking and physical examination) as well as additional testing in function of which organ is affected and to what degree. […] Endometriosis is associated with a long-term increase in healthcare costs.
  • #31 Application of machine learning techniques in the diagnosis of endometriosis | BMC Women’s Health | Full Text
    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03334-2
    Despite this, serum CA125 remains a crucial marker in the diagnosis of EM. […] However, the findings in this area are not yet consistent. […] Currently, the application of machine learning in EM remains in the preliminary exploration stage. While some progress has been made in constructing diagnostic models, their accuracy requires further validation. […] At this stage, it is impractical to rely solely on machine learning models for the diagnosis of EM. However, using these models for patient self-testing and pre-screening triage is feasible and likely to become a focus of future research.
  • #32 Application of machine learning techniques in the diagnosis of endometriosis | BMC Women’s Health | Full Text
    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03334-2
    Despite this, serum CA125 remains a crucial marker in the diagnosis of EM. […] However, the findings in this area are not yet consistent. […] Currently, the application of machine learning in EM remains in the preliminary exploration stage. While some progress has been made in constructing diagnostic models, their accuracy requires further validation. […] At this stage, it is impractical to rely solely on machine learning models for the diagnosis of EM. However, using these models for patient self-testing and pre-screening triage is feasible and likely to become a focus of future research.
  • #33
    https://journals.lww.com/md-journal/fulltext/2024/10180/research_progress_on_correlative_prediction.80.aspx
    Endometriosis is a common benign disease in women of childbearing age, with a malignant change rate of about 1%. […] Early identification of high-risk groups of EMs malignant transformation is of great significance for the prevention and treatment of EAOC. […] However, there is still a lack of specific and sensitive prediction factors. […] A large number of studies have established and validated relevant prediction models to evaluate the condition and prognosis of EMs. […] The relevant prediction factors and prediction models were summarized to provide reference and new thinking for the research of prediction models in the field of EAOC, in order to develop standardized long-term management strategies for high-risk groups of EAOC and realize the advance of the diagnosis threshold of patients with EAOC.

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transformacja złośliwa model predykcyjny krzywa ROC hormonalna terapia zastępcza HE4 marker biochemiczny czynnik prognostyczny torbiel endometrialna czynnik wzrostu śródbłonka naczyniowego endometrioza jajnikowa laparoskopia techniki wspomaganego rozrodu chirurgia laparoskopowa endometrioza nawrót choroby status menopauzalny leczenie farmakologiczne klasyfikacja ASRM algorytm Random Forest wywiad lekarski stosunek neutrofili do limfocytów niepłodność CA125 badanie fizykalne ROMA