The Prognostic Value of Individual Adhesion Scores from the Revised American Fertility Society Classification System for Recurrent Endometriosis

Bo Hyon Yun, Young Eun Jeon, Seung Joo Chon, Joo Hyun Park, Seok Kyo Seo, SiHyun Cho, Young Sik Choi, Ji Sung Lee, Byung Seok Lee
Yonsei medical journal · 2015 · vol. 56(4) , pp. 1079 · doi:10.3349/ymj.2015.56.4.1079 · PMID:26069133 · PMC4479838 · W609221970
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This retrospective study found that a revised American Fertility Society ovarian adhesion score over 24 was an independent risk factor for recurrent endometriosis after conservative laparoscopy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This retrospective cohort study evaluated prognostic value of each component of the revised American Fertility Society (rAFS) classification system for first recurrence of histologically confirmed endometriosis after conservative laparoscopy in 379 women aged 18–49 years, along with preoperative serum CA-125. Over a median 19.0 months of follow-up, 21.2% experienced recurrence, and while several rAFS measures differed between those with and without recurrence, the ovarian adhesion score >24 emerged as the independent risk factor with the highest recurrence risk (hazard ratio 2.948, 95% CI 1.116–7.789). Advanced stage, younger age at surgery, bilateral ovarian cysts at diagnosis, and complete cul-de-sac obliteration were also independent predictors of poor outcome. The study’s major caveat is its retrospective design with median follow-up under 2 years, which may limit generalizability and longer-term prognostic assessment. This paper is centrally about endometriosis—specifically, how individual rAFS adhesion score components predict recurrence after conservative laparoscopy.

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Abstract

PURPOSE: This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrence of endometriosis after conservative laparoscopy. MATERIALS AND METHODS: As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosis at Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperative serum CA-125 levels were retrospectively analyzed to assess their prognostic values for recurrence of endometriosis. RESULTS: Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8±6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovarian cysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116-7.789), p=0.029]. CONCLUSION: Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesion score was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significance in affecting recurrence in the current study.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Laparoscopy Tissue Adhesions Adolescent Adult Cohort Studies Endometriosis Female Fertility Follow-Up Studies Humans Kaplan-Meier Estimate Laparoscopy Middle Aged Prognosis Recurrence Retrospective Studies Risk Factors Treatment Outcome

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