Clinical Outcomes of Uterine Artery Embolization in Adenomyosis With and Without Coexisting Uterine Fibroids or Ovarian Endometrioma: A Retrospective Clinical Analysis.
Uterine artery embolization (UAE) is a minimally invasive therapeutic option for adenomyosis (AM). However, its clinical effectiveness in patients with comorbid gynecologic disorders remains unclear. This study aimed to evaluate the clinical efficacy of UAE in AM patients with or without concomitant uterine fibroids (UFs) or ovarian endometrioma (OE).
A total of 243 women with AM who underwent UAE were retrospectively enrolled, including 141 patients with AM alone, 71 with concomitant UFs, and 31 with concomitant OE. Based on clinical response, 193 patients were classified as having effective treatment outcomes and 50 as ineffective. Baseline demographic and clinical characteristics were recorded. Symptom severity scale (SSS), health-related quality of life (HRQOL), and numerical rating scale (NRS) scores were assessed preoperatively, at 3 months after UAE, and at the last follow-up.
Significant differences in baseline age and cancer antigen 125 (CA125) levels were observed among the three groups (p < 0.05). Postoperatively, all groups showed significant reductions in SSS and NRS scores, as well as significant improvements in HRQOL scores, at both 3 months and the end of follow-up compared with baseline (all p < 0.001). At the final follow-up, patients in the AM + OE group exhibited significantly higher SSS and NRS scores as well as significantly lower HRQOL scores compared with the other two groups (p < 0.05). In contrast, no significant differences were observed between the simple AM and AM + UFs groups. Patients in the effective group were significantly older, had higher parity, lower CA125 levels, and showed a higher incidence of concomitant UFs but a lower incidence of OE compared with the ineffective group (all p < 0.05). HRQOL scores were significantly higher, and NRS scores were significantly lower in the effective group than in the ineffective group at both postoperative time points (all p < 0.001). The overall clinical efficacy rate was 79.42%, with no significant difference between the simple AM and AM + UFs groups (80.85% vs 88.73%, pa = 0.15). However, the clinical efficacy rate was significantly lower in the AM + OE group (51.61%) than in both the simple AM (80.85%, p = 0.001) and AM + UFs (88.73%, p < 0.001) groups. Kaplan-Meier analysis indicated that concomitant OE was associated with an increased risk of treatment failure following UAE.
UAE effectively alleviates symptoms and improves quality of life in patients with AM, particularly in those with isolated AM or concomitant UFs. However, clinical outcomes are less favorable in patients with concomitant OE, suggesting the need for individualized therapeutic strategies in this subgroup.
A total of 243 women with AM who underwent UAE were retrospectively enrolled, including 141 patients with AM alone, 71 with concomitant UFs, and 31 with concomitant OE. Based on clinical response, 193 patients were classified as having effective treatment outcomes and 50 as ineffective. Baseline demographic and clinical characteristics were recorded. Symptom severity scale (SSS), health-related quality of life (HRQOL), and numerical rating scale (NRS) scores were assessed preoperatively, at 3 months after UAE, and at the last follow-up.
Significant differences in baseline age and cancer antigen 125 (CA125) levels were observed among the three groups (p < 0.05). Postoperatively, all groups showed significant reductions in SSS and NRS scores, as well as significant improvements in HRQOL scores, at both 3 months and the end of follow-up compared with baseline (all p < 0.001). At the final follow-up, patients in the AM + OE group exhibited significantly higher SSS and NRS scores as well as significantly lower HRQOL scores compared with the other two groups (p < 0.05). In contrast, no significant differences were observed between the simple AM and AM + UFs groups. Patients in the effective group were significantly older, had higher parity, lower CA125 levels, and showed a higher incidence of concomitant UFs but a lower incidence of OE compared with the ineffective group (all p < 0.05). HRQOL scores were significantly higher, and NRS scores were significantly lower in the effective group than in the ineffective group at both postoperative time points (all p < 0.001). The overall clinical efficacy rate was 79.42%, with no significant difference between the simple AM and AM + UFs groups (80.85% vs 88.73%, pa = 0.15). However, the clinical efficacy rate was significantly lower in the AM + OE group (51.61%) than in both the simple AM (80.85%, p = 0.001) and AM + UFs (88.73%, p < 0.001) groups. Kaplan-Meier analysis indicated that concomitant OE was associated with an increased risk of treatment failure following UAE.
UAE effectively alleviates symptoms and improves quality of life in patients with AM, particularly in those with isolated AM or concomitant UFs. However, clinical outcomes are less favorable in patients with concomitant OE, suggesting the need for individualized therapeutic strategies in this subgroup.