Personalization of the relapse probability and prevention of post-surgery ovarian endometriosis

Introduction. Endometriosis affects about 10 % of reproductive age women and is characterized by a chronic relapsing course. The probability of endometriosis relapse following disease surgical treatment remains very high, which underlies a need to propose reliable, personalized approaches predicting relapse risk for choosing optimal methods to prevent relapse development. Aim : to develop a personalized approach for assessing probability of emergence and measures to prevent ovarian endometriosis relapse following surgical intervention. Materials and Methods . The prospective study examined 148 patients with unilateral endometrioma following surgical treatment; subsequently, the patients were divided into two groups. The main group consisted of 59 patients with endometriosis relapse, the control group included 89 patients without relapse. To create a model for predicting endometriosis relapse, there were used variables referred to categories A, B and C evidence, which increase a risk of developing post-surgery endometriosis. Treatment adherence was assessed using the AQ-25 questionnaire, the stress level – according to the Holmes-Rage method. The relative risk (RR) calculation was used while model constructing. Results . Assessing RR magnitude, there was quantitated a significance of qualitative predictors for endometriosis relapse showing that in case smoking it was 2.4, stress – 2.0, young age (under 25 years) – 2.4, treatment adherence – 3.2, incomplete removal of endometriosis foci – 3.1, and also depended on body mass index (RR = 1.6). Relapse occurred in 18 patients during the first year post-surgery coupled to the maximum number (8.4 ± 0.5) of risk factors. During the following year, 13 new relapse cases were detected coupled to 5.3 ± 0.4 risk factors. During the third year of observation, the number of relapses increased by 12 cases, and the number of risk factors not exceeding 4.6 ± 0.2. Based on the data obtained, the risk index (RI) = n×x (conventional units) was introduced to develop a quantitative approach to assessing the specific timing of relapse development over 4 years taking into account the adverse impact of "n" risk factors on the body over "х" years. Conclusion . In a personalized approach for assessing the risk of endometriosis relapse, the significance of evidence-based medicine qualitative predictors requires quantitative clarification. The proposed RI allows predicting specific relapse timing with > 80 % reliability. The proposed method allows synchronizing intensified preventive measures together with the period of maximum risk of disease development.