Wenwen Wang

Evaluating the psychometric measurement properties of patient-reported outcome measures for uterine fibroids using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines: a systematic review

Objectives To systematically evaluate the psychometric measurement properties of existing patient-reported outcome measures (PROMs) for uterine fibroids using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines and to provide recommendations for the most appropriate tools in clinical and research settings. Design Systematic review using the COSMIN guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data sources The Medline, CINAHL, Embase and Web of Science databases were searched for relevant studies published up to 28 February 2025. Eligibility criteria were studies that targeted patients with uterine fibroids using a PROM instrument and were published as full-text, English-language articles in peer-reviewed journals. Studies that used only a portion or an unvalidated short form of the PROMs, non-English publication or non-peer-reviewed formats were excluded. Data extraction and synthesis Two independent reviewers extracted the data using EndNote V.X9 (Clarivate, London, UK). The PROM quality assessment adhered to the COSMIN guidelines. The level of evidence for the psychometric properties of each PROM was determined using a modified GRADE approach. Results Of 678 records retrieved in the literature search, 11 were included. Six uterine fibroid-specific PROMs were identified and evaluated according to the COSMIN guidelines. The Uterine Fibroid Symptom and Quality of Life (UFS-QoL) and the Bleeding and Pelvic Discomfort Scale (BPD) received class A recommendations (recommended) for sufficient content and structural and internal consistency. However, four other PROMs, namely the Perioperative Anxiety Scale for Uterine Fibroids, Fibroid Symptom Diary, Uterine Fibroid Daily Bleeding Diary and Menstrual Pictogram Superabsorbent Polymer-containing Version 3, received class B recommendations (further research required) due to poor measurement properties, including inadequate reliability and unquantified measurement error. Conclusion The results of the present study fill a knowledge gap in the systematic and comprehensive evaluation of uterine fibroid-related PROMs. These findings provide valuable insights and recommendations for clinicians and researchers seeking reliable PROMs for this patient population. The UFS-QoL and BPD were classified as ‘A’ and were recommended, demonstrating the potential to promote outcome measurements in future studies. PROSPERO registration number CRD42023474806.

Navigating the future landscape of uterine fibroid research: a comprehensive summary of patient-centered outcome measures and implications

Uterine fibroid constitutes a significant burden for affected women and research in this area has increasingly focused on patient-centered outcomes, with patient-reported outcome measures (PROMs) becoming crucial in related studies. We aim to summarize the key aspects and PROMs utilized in previous studies, recommend suitable tools for effective evaluations, and emphasize critical areas for future research. A literature search was conducted in the Medline, CINAHL, Embase, and Web of Science databases, covering the period from inception through October 2024. 75 studies met the criteria for inclusion and these studies highlight that PROMs utilized in research associated with uterine fibroids encompass a wide range of evaluations, spanning from quality of life, menstrual details, psychological well-being, pelvic floor conditions, pain intensity, menopause symptoms, to sexual function, body image, and other related assessments. Despite using various PROMs in published studies, current clinical trials on uterine fibroids mainly rely on general questionnaires, employing questionnaires specifically designed for uterine fibroids. By summarizing the research, we provide an overview of existing PROMs for uterine fibroids, revealing a gap due to the lack of specific PROMs. This review contributes to uterine fibroid research by promoting accurate assessments, leading to better treatment options and enhanced patient quality of life.

Construction of Metastasis-Specific Regulation Network in Ovarian Cancer Based on Prognostic Stemness-Related Signatures

WE aimed to reveal the correlation between ovarian cancer (OV) metastasis and cancer stemness in OV. RNA-seq data and clinical information of 591 OV samples (551 without metastasis and 40 with metastasis) were obtained from TCGA. The edgeR method was used to determine differentially expressed genes (DEGs) and transcription factors (DETFs). Then, mRNA expression-based stemness index was calculated using one-class logistic regression (OCLR). Weighted gene co-expression network analysis (WGCNA) was used to define stemness-related genes (SRGs). Univariate and multivariate Cox proportional hazard regression were conducted to identify the prognostic SRGs (PSRGs). PSRGs, DETFs, and 50 hallmark pathways quantified by gene set variation analysis (GSVA) were integrated into Pearson co-expression analysis. Significant co-expression interactions were utilized to construct an OV metastasis-specific regulation network. Cell communication analysis was carried out based on single cell RNA sequencing data to explore the molecular regulation mechanism of OV. Eventually, assay for targeting accessible-chromatin with high throughout sequencing (ATAC), chromatin immunoprecipitation sequencing (ChIP-seq) validation, and multiple data sets were used to validate the expression levels and prognostic values of key stemness-related signatures. Moreover, connectivity map (CMap) was used to identify potential inhibitors of stemness-related signatures. Based on edgeR, WGCNA, and Cox proportional hazard regression, 22 PSRGs were defined to construct a prognostic prediction model for metastatic OV. In the metastasis-specific regulation network, key TF-PSRS interaction pair was NR4A1-EGR3 (correlation coefficient = 0.81, p < 0.05, positive), and key PSRG-hallmark pathway interaction pair was EGR3-TNFα signaling via NFκB (correlation coefficient = 0.44, p < 0.05, positive), which were validated in multi-omics databases. Thioridazine was postulated to be the most significant compound in treatment of OV metastasis. PSRGs played critical roles in OV metastasis. Specifically, EGR3 was the most significant PSRG, which was positively regulated by DETF NR4A1, inducing metastasis via TNFα signaling.

Status and treatment of patients with uterine fibroids in hospitals in central China: a retrospective study from 2018 to 2021

ObjectiveTo evaluate the hospitalised patients with uterine fibroids (UFs) and describe treatment patterns in hospital-treated patients in central China from 2018 to 2021.DesignA retrospective analysis.SettingThe gynaecology departments of class A and class B secondary and tertiary hospitals in Hubei Province, China.Participants101 008 patients diagnosed with UFs from 1 January 2018 to 31 December 2021.ResultsThe hospitalised patients with UFs increased with age, reaching a peak at ages 45–49 years and then gradually decreasing. Among these patients, 19.05% had anaemia symptoms. Women aged 25–29 years were more likely to be treated with laparoscopic myomectomy (62.22%), while women aged 20–24 years tend to choose open myomectomy (34.58%). Women over age 45 years who had entered perimenopause tended to be treated with laparoscopic hysterectomy (64.85% for those aged 65–69 years). Patients with fibroid with moderate-to-severe anaemia mostly chose hysterectomy. As a whole, the proportion of patients who chose laparoscopic hysterectomy was similar to that of patients who chose laparoscopic myomectomy (31.38% vs 31.14%). Only 2.08% of UFs were treated with high-frequency MRI-guided focused ultrasound surgery (MRgFUS). The number of patients who choose laparoscopic surgery or MRgFUS treatment was increasing year by year. After stratifying by hospital grade, we found that women treated at class A tertiary hospitals were more likely to have laparoscopic than open surgery (66.12% vs 31.26%). At class B secondary hospitals, 61.9% of the patients underwent myomectomy. By contrast, hysterectomy was used to treat the majority of patients at class A secondary hospitals and class B tertiary hospitals (57.79% and 57.57%, respectively). Use of MRgFUS was mainly concentrated within class A tertiary hospitals.ConclusionUFs affect mainly women in childbearing period. Most patients chose to receive treatment at class A tertiary hospitals, among which laparoscopic myomectomy was the mainstream surgical method for patients in Hubei Province.Trial registration numberNCT05840042.

Epidemiology and Risk Factors of Uterine Fibroids in China

Uterine fibroids are the most common form of benign uterine tumors in the uterine muscle layer, which had a certain rate of malignancy, but it is rare. The prevalence of uterine fibroids estimates range from 4.5% to 68.6% depending on study population and diagnostic methodology. The prevalence of fibroids has been historically underestimated by epidemiologic studies which focused mainly on symptomatic women, leaving behind a large population of asymptomatic women and women who underreport their symptoms. What investigators don't know was which women who have fibroids will develop clinical symptoms and which women who have an operation of myomectomy will relapse. The purpose of this study is to investigate the prevalence, incidence and risk factors for the development of uterine fibroids in Chinese women.