Süleyman ÖZEN, Eda GÜNER ÖZEN, Gülin ÖZUYAR ŞİMŞEK, İnci BAŞKIR İŞLEK, Muzaffer SANCI
Anatolian Journal of Obstetrics and Gynecology Research - 2026;3(2):124-130
Purpose: To compare the predictive performance of magnetic resonance imaging (MRI)-based and laparoscopy (LS)-based scoring systems for determining surgical resectability after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer initially considered unsuitable for primary cytoreductive surgery. Methods: This retrospective observational study included consecutive patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treated at a tertiary gynecological oncology center between December 2023 and April 2026. All patients were initially deemed unresectable, received platinum-based NACT, and subsequently underwent post-NACT MRI followed by diagnostic LS for reassessment of surgical feasibility. MRI-peritoneal cancer index (PCI), MRI-Fagotti, LS-PCI, and LS-Fagotti were evaluated. The primary endpoint was successful cytoreduction, defined as complete or optimal interval cytoreductive surgery. Receiver operating characteristic curve analysis was used to assess predictive performance. Results: A total of 42 patients were included. Complete or optimal cytoreduction was achieved in 25 patients (59.5%), while 17 patients (40.5%) underwent suboptimal cytoreduction or were considered unresectable. MRI-based scores showed limited predictive performance, with area under the curve (AUC) values of 0.595 [95% confidence interval (CI), 0.401-0.782] for MRI-PCI and 0.542 (95% CI, 0.362-0.721) for MRI-Fagotti. In contrast, LS-based scores demonstrated substantially higher predictive accuracy. LS-PCI yielded an AUC of 0.913 (95% CI, 0.810-0.989), whereas LS-Fagotti achieved an AUC of 0.991 (95% CI, 0.966-1.000). An LS-Fagotti cutoff value of <=8 predicted successful cytoreduction with 96.0% sensitivity and 100.0% specificity. Conclusion: In patients undergoing reassessment after NACT for advanced ovarian cancer, LS-based scoring systems demonstrated superior predictive performance compared with MRI-based scoring systems. Diagnostic LS remains a valuable tool for selecting candidates for interval cytoreductive surgery and may improve surgical decision-making in the post-NACT setting.
