Fagotti Score (FS) Compared with Peritoneal Cancer Index (PCI) for Preoperative Assessment of Optimal Cytoreduction in Upfront Laparoscopy

Background: Ovarian cancer is the eighth most common cancer in women worldwide. Prognosis in ovarian cancer patients is mainly affected by the complete resectability of the tumor at the time of surgery. Among the methods used to determine resectability are laparotomy, laparoscopy, and imaging techniques. In ovarian cancer patients, the Fagotti Score (FS) and Peritoneal Cancer Index (PCI) can be used during upfront diagnostic laparoscopy to quantify disease burden, resectability, and prognosis. Methods: The aim of this retrospective study was to assess the FS and PCI as tools for predicting optimal cytoreduction (R = 0, <1) and correctly assigning patients for primary debulking surgery (PDS) or interval debulking surgery (IDS). An ROC was used to compare the accuracy of both FS and PCI scores for assessing resectability. Diagnostic measures for both were calculated. Results: A total of 45 patients were ultimately included in this study. The area under the curve was 0.801 for the FS and 0.705 for the laparoscopic PCI, with an optimal cut-off score of 24.5. In our cohort, the FS demonstrated a sensitivity of 90%, a specificity of 64%, a PPV of 66.7%, and an NPV of 88.9%. Similarly, using a cut-off of 24.5, the PCI demonstrated a sensitivity of 80%, a PPV of 59.3%, and an NPV of 56%. Conclusions: Laparoscopic PCI is a useful tool for predicting resectability in ovarian cancer patients. However, when compared with the PCI, it seems that the FS performs better as a predictive score for resectability.