Background/Objectives: Cytoreduction status is a critical prognostic factor in ovarian cancer, yet preoperative selection of patients suitable for primary debulking surgery and accurate prediction of surgical outcome remain challenging. This study aimed to evaluate the prognostic ability of MRI-based Fagotti score and Peritoneal Cancer Index (PCI) for predicting resectability of peritoneal disease in ovarian cancer patients. Methods: This was a prospective single-center observational study. Patients with suspected primary ovarian cancer who underwent preoperative MRI of the abdomen and pelvis with a dedicated protocol were considered. MRI-based Fagotti score and PCI were determined by two readers independently, using a combination of T2W, Diffusion-Weighted Imaging (DWI), and contrast-enhanced T1W sequences. In cases of discordance, a third radiologist reviewed the scans and consensus was reached. ROC analysis and logistic regression were used to evaluate prognostic performance. The reference standard to predict resectability was optimal cytoreduction defined as residual disease ≤1 cm. Results: Forty-six women with epithelial ovarian cancer (mean age 56.3 ± 2.6 years) who underwent preoperative MRI, followed by laparoscopy and/or laparotomy, were included in the study. Both MRI-based Fagotti score and PCI showed high predictive value for predicting resectability (AUC 0.92 and 0.94, respectively). Optimal cut-offs were ≤6 for Fagotti score and ≤20 for PCI. Patients with scores below these thresholds had >60-fold (Fagotti) and >100-fold (PCI) increased odds for successful primary cytoreduction (p< 0.001). Conclusions: MRI-based Fagotti score and PCI may serve as powerful noninvasive predictors of surgical outcome in ovarian cancer. MRI may reliably guide treatment decisions, reducing unnecessary laparotomies and optimizing patient selection.
背景/目的：肿瘤细胞减灭状态是卵巢癌的关键预后因素，然而术前筛选适合初次肿瘤细胞减灭术的患者并准确预测手术结果仍具挑战。本研究旨在评估基于磁共振成像的Fagotti评分和腹膜癌指数对预测卵巢癌患者腹膜疾病可切除性的预后能力。方法：本研究为前瞻性单中心观察性研究。纳入疑似原发性卵巢癌且术前接受专用方案腹部及盆腔磁共振成像检查的患者。由两名阅片者独立使用T2加权、弥散加权成像及对比增强T1加权序列组合，确定基于磁共振成像的Fagotti评分和腹膜癌指数。若出现分歧，则由第三位放射科医师复核影像并达成共识。采用受试者工作特征曲线分析和逻辑回归评估预后效能。预测可切除性的参考标准定义为残留病灶≤1厘米的满意肿瘤细胞减灭术。结果：研究共纳入46例上皮性卵巢癌女性患者（平均年龄56.3±2.6岁），均接受术前磁共振成像检查，后续进行腹腔镜和/或开腹手术。基于磁共振成像的Fagotti评分和腹膜癌指数均对预测可切除性具有较高价值（曲线下面积分别为0.92和0.94）。最佳截断值为Fagotti评分≤6分、腹膜癌指数≤20分。评分低于这些阈值的患者实现满意初次肿瘤细胞减灭术的几率分别提升超过60倍（Fagotti评分）和100倍（腹膜癌指数）（p<0.001）。结论：基于磁共振成像的Fagotti评分和腹膜癌指数可作为卵巢癌手术结局的有效无创预测指标。磁共振成像能可靠指导治疗决策，减少不必要的开腹手术并优化患者选择。
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