Factors associated with advanced-stage endometriosis: A multivariable analysis

Abstract

Endometriosis is a chronic gynecological condition with heterogeneous clinical presentations. This cross-sectional study examined factors associated with advanced-stage endometriosis among 32 women with surgically confirmed disease at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, between December 2024 and July 2025. Endometriosis was classified using the revised American Society for Reproductive Medicine system as minimal–mild (stages I–II) or moderate–severe (stages III–IV). Demographic, reproductive, clinical, and biomarker data (CA-125 and IL-6) were collected. Exploratory multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed. Of 32 women (mean age, 34.2±6.8 years), 24 (75.0%) had stages III–IV disease. Based on the displayed frequencies, advanced-stage disease was more common among nulliparous women (17/19) and women with infertility (18/20), and among those with CA-125 ≥90.67 U/mL (20/22). In the reported adjusted model, CA-125 ≥90.67 U/mL (adjusted odds ratio (aOR): 9.87; 95% confidence interval (CI): 1.45–67.12; p=0.019) and nulliparity (aOR: 6.42; 95%CI: 1.12–36.78; p=0.037) were associated with stages III–IV disease; infertility was retained but was not statistically significant (aOR: 4.95; 95%CI: 0.89–27.54; p=0.067). Apparent discrimination was high (area under the curve: 0.892), but the small sample, data-derived CA-125 threshold, and lack of external validation limit interpretation. These preliminary associations require confirmation in larger studies before clinical implementation.