A novel prognostic index for survival prediction in ovarian cancer: Beyond FIGO staging.

5577 Background: Prognostication in ovarian cancer is traditionally based on FIGO stage, although survival is influenced by additional patient- and treatment-related factors. We developed a new scoring system integrating age, comorbidities, and disease burden to improve survival prediction. Methods: Patients with ovarian malignancies treated with curative intent between June 2016 and November 2024 were identified from a prospectively maintained database. Cox proportional hazards regression was performed for 4-year overall survival (OS). Regression coefficients of significant variables were used to construct a new index. Survival outcomes were assessed using Kaplan–Meier analysis. Predictive performance of new index was compared with FIGO staging using receiver operating characteristic (ROC) analysis. Results: Of 221 consecutive patients, 167 treated with curative intent were analyzed. Median age of the cohort was 52 years (IQR 22–78), and FIGO stage IIIC was most common (45.7%). Optimal cytoreduction was achieved in 80.8%, and 71.3% received adjuvant therapy. At a median follow-up of 38.3 months, recurrence and mortality rates were 32.9% and 26.2%, respectively. The new score incorporated age, total surgical PCI, hypothyroidism, diabetes mellitus, and hypertension with regression-derived coefficients of 0.044, 0.114, 0.329, 0.146, and 0.313 respectively. For each patient, a prognostic index (PI) was calculated as the weighted sum of regression coefficients corresponding to that patient’s covariate profile, using formula, where PI (Prognostic index)= ∑ (β 1 x age) + (β 2 x PCI) + (β 3 x C 1 ) + (β 4 x C 2 )+....(β k x C k ), C 1... C k = individual comorbidities (eg., diabetes, hypertension, etc), if present = 1, absent = 0). Based on the prognostic index, patients were classified into low- (33.75%), intermediate- (31.3%), and high-risk (31.3%) groups. Compared with the low-risk group, OS was worse in the intermediate-risk group (HR 2.37; 95% CI, 0.95–5.91; p = 0.06) and significantly inferior in the high-risk group (HR 7.89; 95% CI, 3.37–18.49; p < 0.001). Disease free survival (DFS) also showed a similar trend. The prognostic index demonstrated superior discrimination compared with FIGO staging (C-index 0.73 vs 0.68; AUC 0.71 vs 0.65) and remained robust on bootstrap internal validation. A prespecified subgroup analysis restricted to FIGO stage III patients was performed and demonstrated superior discrimination for overall survival compared with FIGO staging alone (AUC 0.71 vs 0.61), highlighting prognostic heterogeneity beyond anatomic staging. Conclusions: The prognostic index demonstrated improved discrimination compared with FIGO staging by integrating patient age, comorbidities, and disease burden. This practical, clinically applicable index may facilitate improved risk stratification beyond anatomic staging and may support individualized management strategies in ovarian cancer.