MRI features and chemotherapy response score-based nomogram for post-neoadjuvant recurrence prediction in advanced...

To evaluate pretreatment ADC histogram parameters and chemotherapy response score (CRS) as recurrence predictors in advanced ovarian cancer (OC) treated with neoadjuvant chemotherapy (NACT).

We retrospectively analyzed 101 advanced OC patients who underwent NACT followed by interval debulking surgery. ADC histogram parameters were extracted from adnexal and omental lesions. Multivariate Cox regression identified independent predictors to construct a recurrence risk nomogram. Model performance was validated via calibration, ROC, and decision curve analyses (DCA).

Multivariate analysis identified omental entropy (HR = 0.378; 95% CI, 0.187-0.762), omental CRS (HR = 0.437; 95% CI, 0.244-0.782), residual tumor (HR = 2.419; 95% CI, 1.391-4.206) and post-NACT Ki67 (HR = 1.965; 95% CI, 1.145-3.374) as independent predictors. The incorporation of omental entropy provided significant incremental prognostic value to clinical factors. The nomogram demonstrated good discrimination, with AUCs of 0.813, 0.836, and 0.876 achieved for 1-, 2-, and 3-year recurrence prediction. Patients stratified into the high-risk group exhibited significantly shorter recurrence-free survival than in the low-risk group (p < 0.001). DCA indicated good clinical application value of the model. Additionally, omental entropy served as a significant predictor of pathological chemotherapy response (AUC = 0.702).

Preoperative ADC histogram analysis of omental metastases demonstrated superior predictive value compared to primary adnexal tumors. The developed nomogram, integrating the imaging marker with omental CRS, effectively stratifies recurrence risk to guide personalized management. Additionally, omental ADC parameters correlate with CRS, suggesting their utility as predictors of treatment response.