Clinical and biomarker predictors of pain-related outcomes after endometriosis surgery

- Library Home / - Search Collections / - Open Collections / - Browse Collections / - UBC Theses and Dissertations / - Clinical and biomarker predictors of pain-related outcomes... Open Collections UBC Theses and Dissertations UBC Theses and Dissertations Clinical and biomarker predictors of pain-related outcomes after endometriosis surgery Tucker, Dwayne Ricardo Abstract Endometriosis, defined as endometrium-like tissue outside the uterus, affects 5-10% of reproductive-aged women and an unknown number of gender-diverse individuals. It is characterized by chronic pain that significantly impairs quality of life. The pain pathophysiology of endometriosis is complex, involving central sensitization and peripheral factors (e.g somatic mutations in lesions). While surgery is a common pain treatment, up to 38% of patients experience persistent or recurrent pain, and up to 50% of conservative surgeries require reoperation within five years. Therefore, optimizing surgical candidate selection is crucial to improving pain outcomes. This dissertation utilized a prospective longitudinal cohort at a tertiary centre to: (i) assess the relationship between preoperative pelvic pain comorbidities and pain-related quality of life after endometriosis surgery; (ii) develop and validate a predictive model for pain-related quality of life after endometriosis surgery; and (iii) explore the relationship between patients with Phosphatase and tensin homolog (PTEN) and AT-rich interaction domain 1A (ARID1A) somatic loss, with endometriosis disease burden, clinical outcomes, and reoperation risk. In Chapter 2, I demonstrated that preoperative pelvic pain comorbidities were associated with poorer pain-related quality of life post-surgery (higher Endometriosis Health Profile-30 (EHP-30) pain subscale scores), highlighting their potential as predictors of pain-related outcomes. In Chapter 3, I developed and validated the Endometriosis Pain Index (EPI), a random forest model predicting the probability of poor pain-related quality of life, defined as an EHP-30 score >59% (above the 75th percentile in North America) post-surgery. Using ten preoperative predictors, the EPI achieved an area under the roc curve of 0.768 (bootstrap validation) and 0.766 (validation in independent test data), acceptable calibration and clinical utility (decision curve analysis). It is accessible via an online calculator. Chapter 4 demonstrated that somatic PTEN loss is common in endometriosis, and associated with more severe anatomic subtypes, higher stages, and increased surgical difficulty due to significant anatomical disruption. Overall, this dissertation identified preoperative clinical predictors of poor pain-related quality of life, presented a predictive tool that could support pre-surgical discussions between patients and clinicians pending external validation, and provided further evidence linking somatic alterations to endometriosis disease severity. Item Metadata | Title | Clinical and biomarker predictors of pain-related outcomes after endometriosis surgery | | Creator | | | Supervisor | | | Publisher | University of British Columbia | | Date Issued | 2025 | | Description | Endometriosis, defined as endometrium-like tissue outside the uterus, affects 5-10% of reproductive-aged women and an unknown number of gender-diverse individuals. It is characterized by chronic pain that significantly impairs quality of life. The pain pathophysiology of endometriosis is complex, involving central sensitization and peripheral factors (e.g somatic mutations in lesions). While surgery is a common pain treatment, up to 38% of patients experience persistent or recurrent pain, and up to 50% of conservative surgeries require reoperation within five years. Therefore, optimizing surgical candidate selection is crucial to improving pain outcomes. This dissertation utilized a prospective longitudinal cohort at a tertiary centre to: (i) assess the relationship between preoperative pelvic pain comorbidities and pain-related quality of life after endometriosis surgery; (ii) develop and validate a predictive model for pain-related quality of life after endometriosis surgery; and (iii) explore the relationship between patients with Phosphatase and tensin homolog (PTEN) and AT-rich interaction domain 1A (ARID1A) somatic loss, with endometriosis disease burden, clinical outcomes, and reoperation risk. In Chapter 2, I demonstrated that preoperative pelvic pain comorbidities were associated with poorer pain-related quality of life post-surgery (higher Endometriosis Health Profile-30 (EHP-30) pain subscale scores), highlighting their potential as predictors of pain-related outcomes. In Chapter 3, I developed and validated the Endometriosis Pain Index (EPI), a random forest model predicting the probability of poor pain-related quality of life, defined as an EHP-30 score >59% (above the 75th percentile in North America) post-surgery. Using ten preoperative predictors, the EPI achieved an area under the roc curve of 0.768 (bootstrap validation) and 0.766 (validation in independent test data), acceptable calibration and clinical utility (decision curve analysis). It is accessible via an online calculator. Chapter 4 demonstrated that somatic PTEN loss is common in endometriosis, and associated with more severe anatomic subtypes, higher stages, and increased surgical difficulty due to significant anatomical disruption. Overall, this dissertation identified preoperative clinical predictors of poor pain-related quality of life, presented a predictive tool that could support pre-surgical discussions between patients and clinicians pending external validation, and provided further evidence linking somatic alterations to endometriosis disease severity. | | Genre | | | Type | | | Language | eng | | Date Available | 2026-04-30 | | Provider | Vancouver : University of British Columbia Library | | Rights | Attribution-NonCommercial-NoDerivatives 4.0 International | | DOI | 10.14288/1.0448570 | | URI | | | Degree (Theses) | | | Program (Theses) | | | Affiliation | | | Degree Grantor | University of British Columbia | | Graduation Date | 2025-05 | | Campus | | | Scholarly Level | Graduate | | Rights URI | | | Aggregated Source Repository | DSpace | Item Media Item Citations and Data Rights Attribution-NonCommercial-NoDerivatives 4.0 International