Long-term efficacy of uterine artery embolization for adenomyosis and analysis of prognostic factors: a cohort study

To evaluate the long-term therapeutic efficacy of uterine artery embolization (UAE) for adenomyosis and to identify independent prognostic factors associated with postoperative recurrence. A total of 200 adenomyosis patients who underwent UAE were retrospectively included and categorized into a non-recurrence group and a recurrence group. Baseline characteristics, symptom improvement, and postoperative complications were compared between groups. Recurrence-free survival was assessed using the Kaplan–Meier method. Univariable and multivariable Cox proportional hazards regression analyses were performed to determine independent predictors of recurrence. Patients in the recurrence group were younger, had a longer disease duration, more severe preoperative symptoms, and higher carbohydrate antigen 125 (CA-125) levels. They also had higher proportions of diffuse-type adenomyosis, thicker junctional zones, and more sparsely vascularized lesions. The non-recurrence group showed greater improvement in pain, pictorial blood loss assessment chart (PBAC) scores, and quality of life. The incidence of postoperative complications was higher in the recurrence group (P = 0.024). Kaplan–Meier analysis showed recurrence-free survival rates of 90% at 12 months and approximately 69% at 24 months after UAE. Age (hazard ratio [HR] = 0.903, P = 0.008), junctional zone thickness (HR = 1.333, P < 0.001), and preoperative CA-125 level (HR = 1.029, P < 0.001) were independent prognostic factors. UAE significantly improves symptoms in patients with adenomyosis, with relatively stable efficacy during the first postoperative year, although the risk of recurrence increases thereafter. Younger age, increased junctional zone thickness, and elevated preoperative carbohydrate antigen 125 levels may assist in preoperative risk stratification.