Objective: To establish a prediction model to help the doctor determine which patients are more suitable for transvaginal repair based on the prediction model. Design:All enrolled patients underwent CSD repair performed by a single team. All women in this study had a follow-up clinic visit at 6 months to record their menstruation and measure multiple parameters of the CSD by MRI. Setting:Retrospective study Sample: This study included 1015 women who underwent transvaginal repair of cesarean scar diverticulum (CSD) at Xinhua Hospital and Shanghai First Maternity & Infant Hospital between June 2014 and May 2021. Main outcome measures: CSD patients are categorized as having optimal healing when the menstruation duration is no more than 7 days and the thickness of residual myometrium（TRM） is no less than 5.39 mm after vaginal repair. The final nomogram is constructed to predict surgical outcomes based on pre- and postoperative variables. Results: The key factors determining optimal healing are the timing of cesarean section; menstrual cycle; CSD length, width, depth, and the myometrial layer thickness of the lower uterine segment. With the prediction model, scores are given to each parameter according to the statistics. Total scores range from 0 to 25 points with a cutoff point of 16.5. Predicted that transvaginal repair achieves optimal healing when a score greater than 16.5 points. Uterine position and preoperative TRM are the key factors affecting postoperative TRM. The width of the CSD and the thickness of the lower uterine segment are the key factors affecting postmenstrual abnormal uterine bleeding (P<0.01). Conclusions: We establish a prediction model system for the first time that may predict the repair effect of CSD and can potentially be useful in future clinical trials to determine which patients should be repaired or other treatment options.

Objectives: To evaluate the predictive significance of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in the prognosis of high-grade endometrial carcinoma and to establish a novel predictive model. Design: A retrospective multicenter study. Setting: Fifteen hospitals of the Chinese Endometrial Carcinoma Consortium. Population: This study included 910 high-grade epithelial endometrial carcinoma patients from the multicenter who underwent initial surgical treatment between January 1, 2005, and December 31, 2019. Methods: Data was retrospectively obtained from the medical records and follow-up information of patients. Cox proportional hazard regression models were developed to predict the risk of recurrence and death at 3, 5, and 10 years, and the models were validated and calibrated. The area under the curve was used to measure the predictive performance of the model. Main outcomes measures: Disease-free survival and overall survival. Result: Platelet-lymphocyte ratio and neutrophil-lymphocyte ratio were risk factors for recurrence, and neutrophil-lymphocyte ratio was a risk factor for death. We established models for predicting death and recurrence. In the validation cohort, the area under receiver operating characteristic curve of disease-free survival model at 3,5 and 10 years was 0.72, 0.77, 0.77, and of overall survival model was 0.72, 0.81, and 0.84. Kaplan–Meier survival analysis showed a significant difference between low-risk and high-risk groups. Conclusions: Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are risk factors affecting the prognosis of high-grade endometrial carcinoma patients. This novel prediction model for high-grade endometrial carcinoma can provide accurate postoperative risk classification and prognosis prediction for patients. Keywords: Endometrial carcinoma, prognostic model, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio