A decision-support tool for management of advanced epithelial ovarian cancer in a single centre in India (CT PAUSE Nomogram): a prospective Study (2022–2024)

Background: Accurate preoperative imaging is essential in advanced epithelial ovarian cancer, where complete cytoreduction remains the strongest prognostic factor. This study evaluates the CT PAUSE score-a structured, domain-based reporting tool-for its utility in surgical planning and multi-disciplinary team (MDT) decision-making. Methods: In this prospective cross-sectional study between September 2022 to February 2024, 124 patients with FIGO stage III/IV ovarian cancer underwent 175 contrast-enhanced CT scans. PAUSE components-Peritoneal Cancer Index (PCI), Ascites/abdominal wall disease, Unfavourable sites, Small bowel/mesenteric disease, and Extra-peritoneal metastases-were prospectively scored during evaluation. Interobserver agreement was assessed in a subset of 30 cases. Findings: MDT triage using PAUSE resulted in a complete cytoreduction rate of 89.3%. A simplified nomogram based on upper abdominal disease volume showed discriminatory ability (area under the curve (AUC) [95% CI] = 0.820 [0.740-0.880]) and could be an alternative to the full radiological PCI-based nomogram (AUC) [95% CI] = 0.763 [0.677-0.835]), in busy clinical settings. Interobserver agreement was substantial for both nomogram scores, with higher reliability observed for the score derived from the upper abdominal disease-based nomogram (intraclass correlation coefficient (ICC) [95% CI] = 0.710 [0.582-0.825] versus 0.627 [0.460-0.778]; p < 0.001). Interpretation: CT PAUSE provides a structured approach to radiological reporting and may support more consistent MDT discussions and surgical triage in advanced ovarian cancer. Its performance in this cohort might suggest potential for integration into clinical workflows, pending further validation. Funding: There was no funding source for this study.