Objective: The relationship between surgical outcomes and metastatic sites in ovarian cancer (OC) is known, but the role of metastatic site-specific tumor burden remains unclear.Methods: We prospectively analyzed data from 202 OC patients. We developed a preoperative protocol evaluating tumor burden in 30 metastatic sites and created a predictive score for suboptimal cytoreduction, which was externally validated.Results: MRI-assessed tumor burdens demonstrated superior consistency with surgical findings compared to CT (κ = 0.4–1.0). Three site-specific tumor burdens (diaphragmatic spleen surface, hepatorenal recess, mesentery), upper abdominal tumor burden, and two clinical factors were identified as predictors of suboptimal cytoreduction. The predictive score incorporating these factors achieved an AUC of 0.873 (0.815 externally validated), outperforming metastatic site-integrated scores including the simulated Fagotti score (AUC: 0.656) and Suidan score (AUC: 0.8308). R0 resection rates were inversely correlated with predictive scores: 94.87% for scores of 0–3 versus 8.57% for scores >14. The peak of Youden’s index reached 11, and patients with predictive scores <11 had longer median progression-free survival.Conclusions: We demonstrated that site-specific tumor burden is correlated with surgical outcomes in OC. Incorporating tumor burden into preoperative assessment enhances prediction performance. We developed a clinically applicable tool, marking a shift from evaluating metastatic sites to assessing metastatic site-specific tumor burden.
目的：卵巢癌手术结局与转移部位的关系已知，但转移部位特异性肿瘤负荷的作用尚不明确。方法：我们前瞻性分析了202例卵巢癌患者数据。制定术前评估30个转移部位肿瘤负荷的方案，构建次理想肿瘤细胞减灭术的预测评分并进行外部验证。结果：MRI评估的肿瘤负荷与手术发现的一致性优于CT（κ=0.4-1.0）。三个特定部位肿瘤负荷（膈肌脾面、肝肾隐窝、肠系膜）、上腹部肿瘤负荷及两个临床因素被确定为次理想肿瘤细胞减灭术的预测因子。整合这些因素的预测评分AUC达0.873（外部验证0.815），优于包含模拟Fagotti评分（AUC：0.656）和Suidan评分（AUC：0.8308）在内的转移部位综合评分。R0切除率与预测评分呈负相关：评分0-3分者达94.87%，>14分者仅8.57%。约登指数峰值达11分，预测评分<11分的患者中位无进展生存期更长。结论：我们证实特定部位肿瘤负荷与卵巢癌手术结局相关。将肿瘤负荷纳入术前评估可提升预测效能。我们开发了具有临床适用性的评估工具，标志着从评估转移部位向评估转移部位特异性肿瘤负荷的转变。
肿瘤(癌症)患者之家