Abstract
Positive ascites cytology is a known poor prognostic factor in ovarian cancer, but its impact after neoadjuvant chemotherapy (NAC) with complete tumor resection remains unclear. Among 4944 patients, 191 underwent primary debulking surgery (PDS) and 59 underwent NAC followed by interval debulking surgery (NAC-IDS), all achieving R0 resection at stage III. Kaplan–Meier, univariate, and multivariate analyses were performed. Positive ascites cytology was independently associated with higher recurrence and mortality at 5 years [odds ratio (OR) of recurrence at 5 years = 2.412, P = 0.003; OR of mortality at 5 years = 2.025, P = 0.010]. Subgroup analysis showed greater risk in NAC-IDS than in PDS [NAC-IDS: HR of PFS = 2.003, P = 0.029; HR of OS = 3.259, P = 0.006; PDS: HR of PFS = 1.549, P = 0.031; HR of OS = 1.789, P = 0.018]. The interaction effect analysis suggested that positive ascites cytology was associated with a higher risk of mortality at 5 years in NAC patients than in PDS patients [OR of NAC-IDS = 3.722, OR of PDS = 1.151, OR for interaction = 3.234]. The present results indicate that positive ascites cytology in NAC-IDS predicts poor survival outcomes in patients with advanced ovarian cancer.
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The clinical datasets analyzed during the current study are not publicly available due to patient privacy and institutional ethical restrictions, but are available from the corresponding author on reasonable request.
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Acknowledgements
Acknowledgements: We sincerely thank members belonging to TOTSG-affiliated institutions for collaborating in data collection. We are grateful to E. Miyamoto, A. Kunishima, H. Fujimoto, S. Iyoshi and K. Mogi for helpful discussions. We would like to thank Medical English Service (www.med-english.com) for English language editing. This work was supported by a fellowship of the “Nagoya University CIBoG WISE program” from MEXT, and THERS Make New Standards Program for the Next Generation Reseaerchers” from JST SPRING, Grant Number JPMJSP2125.
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Marina Yoshikawa: Conceptualization, Formal analysis, Investigation, Resources, Software, Visualization, Writing-original draft Masato Yoshihara (Corresponding Author): Conceptualization, Data curation, Project administration, Writing-review&editing Ryo Emoto: Methodology, Validation Shigeyuki Matsui: Methodology, Supervision, Validation Hiroaki Kajiyama: Funding acquisition, Supervision.
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Yoshikawa, M., Yoshihara, M., Emoto, R. et al. Positive ascites cytology in interval debulking surgery predicts poor outcomes of advanced epithelial ovarian cancer achieving complete tumor resection. Sci Rep (2026). https://doi.org/10.1038/s41598-026-37664-y
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DOI: https://doi.org/10.1038/s41598-026-37664-y
