Introduction/Background Current ESGO guidelines recommend secondary cytoreductive surgery (SCS) followed by chemotherapy in case of first recurrent epithelial ovarian cancer and a platinum-free interval (TFIp) of >6 months as it is the best strategy to prolong progression free survival (PFS) and overall survival (OS). Two prediction models have been developed to improve patient selection for complete resection: AGO and iMODEL. Whole-body diffusion-weighted MRI (WB-DWI/MRI) is a powerful tool to predict resectable disease, however, it has not yet been integrated in the two prediction models. Our aim was to identify the best tool for prediction of resectable disease.

Methodology A retrospective cohort study was performed in the University Hospitals Leuven, a tertiary referral centre, using a database search identifying patients between January 2012 and December 2021. Inclusion criteria were: (a) first relapse after 6+ months TFIp, and (b) WB-DWI/MRI. AGO and iMODEL scores were calculated when MRI demonstrated resectable disease.

Results In total, 246 patients were included. Based on the WB-DWI/MRI, 124 (50.4%) underwent SCS. The performance of WB-DWI/MRI, AGO, and iMODEL score are summarized in Table 1. WB-DWI/MRI (without the use of any model) had the highest accuracy (89%) compared with the addition of AGO and iMODEL scores: 44.6% (p<0.001) and 80.2% (p=0.54), respectively. Adding the AGO or iMODEL score had a negative effect on both the sensitivity and specificity in predicting resectable disease.

Furthermore, when WB-DWI/MRI revealed resectable disease, these patients had a significant longer median PFS: 42.9 months vs. 10.0 months (Hazard Ratio [HR]: 0.35; 95%CI 0.26–0.48) and median OS: 64.9 months vs. 31.4 months (HR: 0.36; 95%CI 0.25–0.53) for resectable versus non-resectable disease, respectively.

Conclusion WB-DWI/MRI was the most suitable modality for the prediction of resectable disease at the time of SCS. Adding AGO or iMODEL score did not improve prediction of operable disease in our centre.