Patient Selection Metrics and Efficacy of Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Retrospective Analysis

Fathima Anooshiya Mohamed Hassan Abdul Razak,1,* Hui Zong,1,* Jie Gao,1 Renzhuo Gao,1 Shuyan Zhao,2 Jin Peng,1 Hui Zhang1 1Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji’nan, Shandong, People’s Republic of China; 2Department of Obstetrics and Gynecology, Yiyuan County People’s Hospital, Zibo, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jin Peng, Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, 107 West Wenhua Road, Ji’nan, Shandong, 250012, People’s Republic of China, Email [email protected] Hui Zhang, Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, 107 West Wenhua Road, Ji’nan, Shandong, 250012, People’s Republic of China, Email [email protected]: To evaluate risk factors of overall survival (OS) in patients with advanced epithelial ovarian cancer (AEOC) and establish predictive models for predicting postoperative complete cytoreduction (R0 resection) in AEOC patients to guide individualized treatment (PDS or NACT-IDS).Material and Methods: This retrospective analysis of 818 AEOC patients treated at Qilu Hospital of Shandong University between January 2014 and December 2023 compared survival outcomes (OS, PFS) and R0 rates following PDS vs. NACT-IDS using Cox regression and Kaplan-Meier methods. Based on the PDS and NACT-IDS group, two predictive models were established using logistic regression analysis to predict postoperative R0 resection.Results: Patients undergoing NACT-IDS treatment have a heavier tumor burden and a higher R0 resection rate (56.40% vs 39.90%, P < 0.001) than those undergoing PDS treatment. Median OS was modestly longer following PDS (32 vs 29 months, P = 0.036), while PFS did not differ between strategies. Multivariate Cox regression identified age, CA153, serum total calcium, and non-R0 as independent risk factors of OS, in contrast, the treatment strategy was not statistically significant. The Suidan score demonstrated high sensitivity for predicting complete resection (94.09%) but limited specificity (18.02%). Preoperative predictive models integrating CA153 and the Suidan score showed moderate discrimination in the PDS cohort (AUC = 0.763/0.705, training set/validation set) and excellent performance in the IDS cohort (AUC = 0.911) with good calibration (Hosmer-Lemeshow P > 0.05).Conclusion: Complete cytoreduction remains the most critical determinant of survival in AEOC. Preoperative models combining CA153 and the Suidan score provide practical tools to support individualized selection of PDS or NACT-IDS strategies.Clinical Trial Number: ChiCTR2600116858.Keywords: advanced epithelial ovarian cancer, primary debulking surgery, interval debulking surgery, CA153, predictive modeling, suidan score, complete cytoreduction