Reproducibility of positive AGO score in predicting complete cytoreduction in recurrent low-grade ovarian cancers

The Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score has been proposed to facilitate patient selection for secondary cytoreductive surgery. However, this model has not been validated for low-grade subtypes of ovarian cancer. This study evaluates the reproducibility of a positive AGO score in predicting complete resection in recurrent low-grade epithelial cancers.

We retrospectively analyzed 76 patients with recurrent grade-I serous, grade-I/II endometrioid, and mucinous ovarian cancers who underwent cytoreductive surgery between January 2001 and April 2023. Univariate and logistic regression analyses were performed to evaluate associations between clinical factors and surgical outcomes.

Complete resection was achieved in 31 of 55 patients (56.3%) undergoing surgery at first recurrence and in 9 of 21 patients (42.9%) in subsequent treatment lines. Among patients experiencing first recurrence with a treatment-free interval of ≥6 months, the positive predictive value of the AGO score for complete resection was 70.6%. However, multivariate analysis revealed that Eastern Cooperative Oncology Group score (p = .62), International Federation of Gynecology and Obstetrics stage (p = 1.00), ascites (p = .14), and residual disease after primary surgery (p = .59) were not independent predictors of complete resection at first recurrence. Results were consistent in subgroup analyses, including serous and endometrioid subtypes with a treatment-free interval of ≥6 months. Ascites ≥500 mL was present in only 7.9% of patients, while 92.1% had no or low-volume (<500 mL) ascites. Diffuse carcinomatosis was observed in 58.7% of patients. In patients who had achieved complete resection at primary surgery, a treatment-free interval of >28 months was associated with higher complete resection rates (83.3% vs 50%, p = .038).

Our study highlights a critical limitation of the AGO score in low-grade ovarian cancers. None of the clinical elements included in the AGO score were independently associated with surgical results. Despite the high positive predictive value, a positive AGO score may not reliably predict complete resection in patients with recurrent low-grade ovarian cancers and should be interpreted with caution.