Association of Fibrosis-Related Gene Expression Profiles in Benign Ureteral Stricture Tissue With Restenosis After Ureteroplasty.

To investigate fibrosis-related gene expression profiles in benign ureteral strictures and their association with restenosis after ureteroplasty and to develop a predictive risk score model. A total of 100 patients with benign strictures who underwent ureteroplasty were included.Stenotic tissues were collected intraoperatively, and the expression levels of 15 fibrosis-related genes were determined by quantitative real-time PCR. According to whether restenosis occurred at 12 months postoperatively, the patients were assigned to stenotic group (n = 39) and non-stenotic group (n = 61). Independent predictors were identified using logistic regression, a risk score model was constructed and model performance was assessed using receiver operating characteristic curve, calibration curves and decision curve analysis (DCA). The restenosis-free rates of the risk groups were compared through Kaplan-Meier survival analysis, and internal validation was performed through Bootstrap resampling. High expression levels of type I collagen α1 chain (COL1A1), transforming growth factor-β1 (TGFB1), Snail family member 1 (SNAI1), SMAD family member 3 (SMAD3) and thrombospondin 2 (THBS2) genes were identified as independent risk factors for postoperative restenosis (all p < 0.05). Kaplan-Meier analysis revealed that the restenosis-free rate at 12 months was significantly lower in the high-risk group than in the low-risk group (51.02% vs. 70.59%, log-rank p = 0.007). The area under the curve (AUC) of the risk scoring model was 0.854 [95% confidence interval (CI): 0.772-0.973], with a sensitivity of 87.12% and specificity of 84.55%. Bootstrap internal validation yielded a corrected AUC of 0.848 (95% CI: 0.812-0.891), confirming the model's stability. The calibration curve demonstrated good agreement between predicted probabilities and observed outcomes (Hosmer-Lemeshow test, p > 0.05). DCA showed that the model provided a net clinical benefit across a wide range of threshold probabilities. Further analysis showed that the expression levels of the above five genes were significantly positively correlated with the pathological fibrosis grade of stenotic tissues (all p < 0.001). The high expression levels of COL1A1, TGFB1, SNAI1, SMAD3 and THBS2 in benign ureteral strictures is closely related to the degree of tissue fibrosis and postoperative restenosis. The risk scoring model based on these genes showed good predictive performance and can thus serve as useful tool for clinical individualised treatment and prognostic assessment.