# Positive ascites cytology in interval debulking surgery predicts poor outcomes of advanced epithelial ovarian cancer achieving complete tumor resection

## TL;DR

Positive ascites cytology after surgery with prior chemotherapy predicts worse survival in advanced ovarian cancer patients who achieve complete tumor removal.

## Contribution

The study identifies positive ascites cytology as an independent predictor of poor outcomes in NAC-IDS patients with complete tumor resection.

## Key findings

- Positive ascites cytology is independently linked to higher recurrence and mortality at 5 years.
- NAC-IDS patients with positive cytology face a higher risk of mortality than PDS patients.
- Interaction analysis shows a stronger mortality risk in NAC-IDS compared to PDS patients with positive cytology.

## 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.

The online version contains supplementary material available at 10.1038/s41598-026-37664-y.