Recurrence after hysteroscopic myomectomy for FIGO type II submucosal myomas: a retrospective cohort study

BACKGROUND: We aimed to investigate the influencing factors for recurrence of International Federation of Gynaecology and Obstetrics (FIGO) type II submucosal myoma with a diameter of 4-5 cm following hysteroscopic myomectomy, and to establish an individualised prediction model for the risk of postoperative 3-year recurrence. METHODS: In this single-centre retrospective cohort study, patients undergoing hysteroscopic myomectomy between January 2017 and June 2025 were included. Recurrence-free survival was assessed using the Kaplan-Meier method. Candidate variables were initially screened using LASSO-Cox regression with 10-fold cross-validation for λ selection, followed by multivariable Cox regression. Multicollinearity among candidate predictors was assessed using variance inflation factors. A nomogram was constructed to predict 3-year recurrence risk. Model performance was evaluated by bootstrap validation, including discrimination (C-index), calibration (calibration curve and Brier score), and clinical utility (decision curve analysis). RESULTS: < 0.05). The nomogram showed favourable discrimination, calibration, and clinical net benefit. CONCLUSIONS: Recurrence after hysteroscopic myomectomy was associated with tumour characteristics, surgical complexity, and postoperative hormonal therapy. The nomogram showed favourable performance, with a bootstrap-corrected C-index of 0.811, a 3-year Brier score of 0.099, and clinical net benefit across threshold probabilities of approximately 0.05-0.45. This exploratory model may support individualised 3-year recurrence risk stratification and guide follow-up and adjuvant treatment planning.