{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:20:04Z","timestamp":1787653204759,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify the risk factors associated with postoperative recurrence of unusual (special\u2010type) uterine smooth muscle neoplasia (USMN) and to construct and interpret a machine\u2010learning model for recurrence risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We carried out a retrospective review of patients who had myomectomy for uterine masses at the Third Xiangya Hospital between January 2015 and December 2024, zeroing in on those with paraffin\u2010confirmed special variants\u2014specifically cellular, atypical\/bizarre, and vascular leiomyomas. After a negative transvaginal ultrasound at the 3\u2010month mark, we tracked recurrence over the next 12\u2009months, assigning patients to either the recurrence or non\u2010recurrence groups. The full cohort was randomly split 7:3 into a training set and a hold\u2010out validation set. For missing data within the training portion, we turned to random forest imputation. To pin down the most relevant predictors, we first ran LASSO regression for screening, then solidified our choices using multivariable logistic regression. On the modeling front, we put eight distinct algorithms head\u2010to\u2010head: logistic regression, support vector machine, random forest, gradient boosting machine, XGBoost, k\u2010nearest neighbors, AdaBoost, and a neural network. All were compared across the validation set, with a close eye on discrimination, calibration, and net benefit. The winner among them was later unpacked via SHAP to see exactly how each feature drove predictions. As for the surgical approach, we examined its link to recurrence using two separate strategies\u2014inverse probability of treatment weighting and pairwise propensity\u2010score matching\u2014to ensure the association wasn't driven by confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After screening 285 patients, we analyzed 248, among whom 87 (35.1%) had a recurrence within the first year. Multivariable logistic regression singled out six independent predictors: intramural location, T\n                      <jats:sub>2<\/jats:sub>\n                      WI hyperintensity, tumor multiplicity (\u2265\u20092), size \u2265\u20096\u2009cm, raised BMI, and coexisting adenomyosis (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). No significant difference in recurrence rates was observed across subtypes (cellular 35.6%, atypical 38.5%, vascular 31.0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.793). Neither IPTW nor propensity\u2010score matching revealed an independent association between surgical approach and recurrence. Of the eight models tested, GBM yielded the best performance on validation (AUC 0.785, sensitivity 0.750, F1 0.679). SHAP analysis further pinpointed those same six variables as top contributors and corroborated their effect directions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Taken together, special\u2010type USMN entails a notable risk of early recurrence. Our GBM model, which relies on six easily obtainable preoperative factors, demonstrated reasonable discriminative ability; coupled with SHAP explanation, it could aid in personalized patient counseling and surveillance planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.70439","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:06:59Z","timestamp":1787011619000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of Postoperative Recurrence in Patients With Unusual Smooth Muscle Neoplasia and Construction of a Prediction Model"],"prefix":"10.1111","volume":"52","author":[{"given":"Weiwei","family":"Hu","sequence":"first","affiliation":[{"name":"The Third Xiangya Hospital, Central South University  Changsha Hunan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiying","family":"Wu","sequence":"additional","affiliation":[{"name":"The Third Xiangya Hospital, Central South University  Changsha Hunan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingxi","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Third Xiangya Hospital, Central South University  Changsha Hunan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueran","family":"Li","sequence":"additional","affiliation":[{"name":"The Third Xiangya Hospital, Central South University  Changsha Hunan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangyang","family":"Zeng","sequence":"additional","affiliation":[{"name":"The Third Xiangya Hospital, Central South University  Changsha Hunan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1932-8052","authenticated-orcid":false,"given":"Songshu","family":"Xiao","sequence":"additional","affiliation":[{"name":"The Third Xiangya Hospital, Central South University  Changsha Hunan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"issue":"12","key":"e_1_2_12_2_1","first-page":"884","article-title":"Classification and Diagnosis and Treatment Points of Special Types of Uterine Leiomyomas","volume":"28","author":"Di W.","year":"2012","journal-title":"Chinese Journal of Practical Gynecology and Obstetrics"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.5603\/GP.a2021.0125"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14640"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3182893f36"},{"issue":"2","key":"e_1_2_12_6_1","first-page":"285","article-title":"An Update on Uterine Smooth Muscle Tumors: Is It a Leiomyoma, a STUMP, or a Leiomyosarcoma?","volume":"14","author":"Satala C. B.","year":"2026","journal-title":"Biomedicine"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16359"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14092323"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.14870"},{"issue":"6","key":"e_1_2_12_10_1","first-page":"3207","article-title":"Analysis of Clinical Efficacy and Safety of Laparoscopic Myomectomy for Uterine Fibroids","volume":"37","author":"Zeng Z.","year":"2023","journal-title":"Journal of Biological Regulators and Homeostatic Agents"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.5603\/GP.2016.0054"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2014.05.029"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010933404324"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1013203451"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/cts.70056"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.4274\/gulhane.galenos.2021.1315"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S515545"},{"issue":"18","key":"e_1_2_12_18_1","first-page":"2805","article-title":"Related Factors and Pathological Analysis of Recurrence of Special\u2010Type Uterine Leiomyoma After Laparoscopic Surgery","volume":"41","author":"Sun L.","year":"2019","journal-title":"Hebei Medical Journal"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2019.07.007"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-64285-w"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.21037\/gs-23-92"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.2119\/molmed.2014.00053"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmw023"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-024-03530-0"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2023.03.006"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000046828"}],"container-title":["Journal of Obstetrics and Gynaecology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jog.70439","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jog.70439","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jog.70439","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:34:42Z","timestamp":1787650482000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/jog.70439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":25,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/jog.70439"],"URL":"https:\/\/doi.org\/10.1111\/jog.70439","archive":["Portico"],"relation":{},"ISSN":["1341-8076","1447-0756"],"issn-type":[{"value":"1341-8076","type":"print"},{"value":"1447-0756","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-01-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70439"}}