Search Results (104)

Peritoneal carcinomatosis (PC) is a common, prognostically unfavorable manifestation of advanced gastrointestinal and gynecological malignancies whose treatment is constrained by the blood-peritoneal barrier, which limits drug penetration even when cytoreductive surgery is combined with systemic chemotherapy. This review evaluates current intraperitoneal treatment modalities and emerging technologies for overcoming this limitation, based on recent clinical trials and meta-analyses identified through Scopus and PubMed. We sequentially examine conventional intraperitoneal chemotherapy (IPC); hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian, gastric, and colorectal cancers, with attention to patient selection and the peritoneal cancer index as determinants of survival benefit; pressurized intraperitoneal aerosol chemotherapy (PIPAC) and its electrostatic precipitation variant (ePIPAC); and photodynamic and photothermal therapy for tumor treatment. Novel strategies are also discussed, including IPC combined with immune checkpoint inhibitors, optical dosimetry, and nanomedicine-based drug delivery as tools for improving treatment precision. Overall, management of PC is transitioning toward a personalized, multimodal approach: HIPEC and PIPAC provide standardized platforms for regional therapy, but future progress depends on integrating advanced drug delivery systems, immunotherapy, and real-time intraoperative monitoring, with standardization of protocols through large multicenter trials remaining a priority for translating these modalities into clinical practice. Full article

Background: Platinum-resistant ovarian cancer with peritoneal metastases remains a therapeutic frontier marked by limited systemic efficacy and a persistent unmet clinical need for effective locoregional strategies. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel minimally invasive platform designed to enhance intraperitoneal drug distribution and overcome biological barriers to chemotherapy delivery. Methods: We performed a PRISMA-compliant systematic review and meta-analysis evaluating clinical outcomes of PIPAC in platinum-resistant ovarian cancer. Primary endpoints included histologic regression (PRGS ≤ 2), severe toxicity, and 12-month overall survival, complemented by exploratory analyses of treatment feasibility, disease burden dynamics, and bidirectional therapy strategies. Results: PIPAC demonstrated a consistent signal of biologic activity, with pooled histologic response rates indicating meaningful tumor regression despite advanced disease. Severe toxicity remained low across studies, supporting the favorable tolerability of repeated intraperitoneal treatment. Survival outcomes were clinically relevant for a heavily pretreated population, while feasibility analyses suggested that PIPAC may facilitate downstream surgical opportunities in selected patients. Exploratory findings further supported the concept of intraperitoneal disease modulation, reflected by reductions in peritoneal cancer index and integration within multimodal treatment pathways. Conclusions: Beyond a purely palliative intervention, PIPAC may represent a biologically active component of personalized treatment strategies for platinum-resistant ovarian cancer. These findings redefine the therapeutic narrative from symptom control toward disease modulation and treatment escalation, underscoring the need for prospective trials to refine patient selection and optimize multimodal sequencing. Full article

Background: Aspirin, initially recognized for its anti-inflammatory, antipyretic and analgesic properties, holds a prominent role in the treatment of cardiovascular disease. The utility of aspirin in cancer therapeutics has been explored and stratified into COX-dependent and -independent mechanisms. COX2 gene expression has been demonstrated to be significantly upregulated in colorectal cancer and various other gastrointestinal malignancies including pancreatic, esophageal, and gastric cancer. This study investigates the relationship of aspirin use and outcomes in patients with colorectal cancer. Methods: The Nationwide Inpatient Sample (NIS) database from 2017 to 2022 was analyzed for patients age > 18 who were hospitalized for colorectal cancer and its decompensations using ICD-10 diagnostic codes. These patients were further stratified based on the long-term use of aspirin. The principal outcome of this investigation are the odds of in-hospital mortality, with secondary outcomes including odds of pulmonary embolism, portal vein thrombosis, acute kidney injury, septic shock, requiring an ICU level of care and odds of hepatic, pulmonary, gastrointestinal and peritoneal or retroperitoneal metastatic disease. Multivariate logistic regression accounting for hospital and patient characteristics was implemented for analysis, with the Charlson Comorbidity Index used to adjust for coexisting comorbidity burden; a p-value (p) of <0.05 was considered statistically significant. Results: In our analysis of the NIS, 596,160 patients were identified with colorectal cancer and 11.7% (69,750) of this population were identified with long-term use of aspirin. Aspirin use was identified to have a significantly reduced odds of in-patient mortality (adjusted odds ratio) [aOR] 0.530, p value < 0.001 95% CI (confidence interval): 0.460–0.617. Patients with aspirin use also demonstrated significantly reduced odds of adverse outcomes and gastrointestinal, hepatic, pulmonary and retroperitoneal/peritoneal metastasis; (aOR 0.606, 95% CI: 0.564–0.653, p < 0.001), (aOR 0.628, 95% CI: 0.582–0.678, p < 0.001), (aOR 0.676, 95% CI: 0.605–0.755, p < 0.001) and (aOR 0.751, 95% CI: 0.685–0.825, p < 0.001) respectively. Conclusions: In recent years, there has been an alarming increase in incidence of colorectal cancer, particularly amongst younger individuals with increased associated mortality. This mortality increase, albeit alarming, is a driving force for treatment innovation with continual examination of our repertoire of medications for possible repurposed applications. COX2-mediated signaling serves as a key promotor of tumorigenic molecular signaling that directly contributes to tumor cell proliferation, angiogenesis and metastasis in colorectal cancer. Aspirin use and its inhibitory action on COX2 demonstrated a significantly reduced odds of in-hospital mortality. Aspirin use is also associated with significantly reduced odds of developing metastatic disease to the liver, gastrointestinal system, lungs and peritoneum in patients with colorectal cancer. These findings convey that aspirin use reduces the likelihood of in-hospital mortality, major comorbid conditions and of developing metastatic disease as compared to those who do not use aspirin. Full article

Background/Objectives: Peritoneal metastasis represents the most frequent and prognostically unfavorable metastatic pattern in gastric cancer, largely due to limited sensitivity of conventional imaging, delayed diagnosis, and insufficient response assessment. The aim of this review is to provide an overview of the current evidence on the diagnosis and treatment of gastric cancer with peritoneal metastases and to address current treatment limitations and options. Methods: This review was designed as a narrative review and is based on an extensive literature search in established databases. Results: Systemic chemotherapy remains the cornerstone of palliative treatment, improving the survival and quality of life compared with the best supportive care; however, outcomes in peritoneally metastatic disease remain poor. Advances in molecularly targeted and immune-based therapies have extended survival in selected patient populations, yet favorable molecular profiles are mainly unknown in peritoneal metastases. Staging laparoscopy and semi-quantitative assessment using the Peritoneal Cancer Index (PCI) are therefore essential for accurate diagnosis, prognostication, and treatment selection. Growing evidence from retrospective studies, multi-institutional cohorts, and selected randomized trials suggests that a multimodal approach—combining systemic therapy with intraperitoneal or bidirectional chemotherapy—may improve survival and quality of life. In carefully selected patients whose primary gastric tumor and peritoneal lesions respond to systemic treatment, complete cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) may further enhance outcomes and, in rare cases, achieve long-term survival. These potential benefits appear to be limited to highly selected patients with a low peritoneal tumor burden (PCI ≤ 6–7), positive cytology, good performance status, controlled extraperitoneal disease, and a high likelihood of achieving complete macroscopic cytoreduction (CC-0). Conclusions: Although the treatment intent in metastatic gastric cancer remains primarily palliative, carefully selected patients with limited peritoneal metastases may benefit from intensified multimodal treatment strategies when managed in specialized centers. Interdisciplinary evaluation, accurate staging, and individualized treatment planning are essential to optimize outcomes in this challenging disease setting. Full article

Background: Owing to significant clinical heterogeneity, the achievement of accurate survival forecasting for individuals with colorectal cancer and peritoneal metastasis continues to be a complex undertaking. We aimed to transcend traditional prognostic limitations by evaluating machine learning boosting models against standard regression-based methods in terms of estimating overall survival (OS). Methods: Utilizing a multi-institutional registry of 150 patients diagnosed with synchronous peritoneal metastasis of colorectal cancer, we integrated 124 clinicopathological variables to refine our predictive models. Beyond standard preprocessing—including standardization and median imputation—we rigorously compared XGBoost and LightGBM against Ridge, Lasso, and linear regression via five-fold cross-validation. To specifically address right-censoring, an XGBoost Cox model was implemented and validated using Harrell’s C-index, with SHAP and LIME providing essential model interpretability. Results: Boosting models consistently outperformed linear alternatives, which struggled with high error rates and negative R2 values. Specifically, XGBoost achieved an MAE of 475 ± 60 and an RMSE of 585 ± 88. The XGBoost Cox model reached a C-index of 0.64 ± 0.06. SHAP analysis highlighted inflammatory markers and peritoneal disease extent as the most influential prognostic drivers. Conclusions: While boosting models offer a clear accuracy advantage over linear methods, their prognostic power remains moderate. These findings underscore the potential of ensemble learning in oncology, yet mandate external validation before these tools can be integrated into clinical decision-making. Full article

Background: Endometrial cancer (EC) is the most common gynecological malignancy in Western countries. Although international guidelines recommend that patients with EC be treated at specialized oncology centers, many are still managed by general gynecologists. This study aimed to evaluate the influence of facility volume on treatment strategies and survival outcomes among EC patients. Methods: This is a retrospective multicenter study comparing 971 patients with EC treated at medium-volume centers (CVMs) (11–29 cases/year) with 1431 patients treated at high-volume centers (CVAs) (≥30 cases/year). Patient characteristics were recorded, including age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, comorbidities, surgical approach, lymphadenectomy, total number of lymph nodes removed, number of positive lymph nodes, length of hospital stay, histological characteristics, ESMO-ESGO (European Society for Medical Oncology–European Society of Gynaecological Oncology) classification system, adjuvant treatment, recurrence, progression-free survival (PFS), and overall survival (OS). Postoperative fever, hemoglobin changes, and blood transfusions were also reported. Results: Compared with patients treated at the MVCs, patients treated at the HVCs were younger (mean age, 65 vs. 66.4 years, p = 0.03) and had a lower rate of comorbidities (41% vs. 55%, p < 0.001). Patients treated at HVCs were mostly in higher ESMO-ESGO recurrence risk classes (p < 0.001), were treated mostly laparoscopically (58% vs. 47%, p < 0.001) and had better staging (higher number of lymph nodes harvested (mean 19 vs. 11, p < 0.001) and more peritoneal biopsies performed (27% vs. 14%, p < 0.001). HVC patients had fewer complications and received less adjuvant therapy (40% vs. 50%, p < 0.001) but, when treated, received chemotherapy more frequently, showed mostly loco-regional recurrences (34% vs. 14%) and fewer extra-abdominal recurrences (34% vs. 54%). HVC patients had better PFS and OS. Center volume was found to be an independent factor influencing PFS in multivariate analysis. Conclusions: All EC patients should be centrally managed to receive superior treatment to improve postoperative recovery and oncological outcomes, particularly for patients with more-aggressive tumors. Full article

Background/Objectives: While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) significantly improve the outcome of pseudomyxoma peritonei (PMP) patients, recurrence remains a concern, highlighting the need for careful patient selection. This systematic review and meta-analysis evaluated the clinical-pathological, (immuno-) histological, and molecular prognostic factors in PMP patients undergoing CRS and HIPEC. Methods: Databases including PubMed, MEDLINE, Cochrane library, Embase, Scopus, and Web of Science were searched up to July 2024. Studies assessing clinical-pathological, (immuno-) histological, and molecular parameters influencing overall, progression-free, and/or disease-free survival were included. Statistical analysis was performed using R (Version 4.4.3) with random-effect models employed to address heterogeneity. Subsequent subgroup analyses were conducted to investigate potential sources of publication bias (Egger test). Results: A total of 16 studies involving 4009 PMP patients were included. Age, sex (male), completeness of cytoreduction score, peritoneal cancer index, tumor markers (CEA, CA 19-9, CA-125), tumor grade (high), histological subtype, and Ki-67 were significantly associated with prognosis prediction. Conclusions: Despite the presence of heterogeneity and publication bias, clinical-pathological and (immuno-) histological parameters were significantly associated with prognosis in PMP. The findings highlight the importance of integrating clinical-pathological and (immuno-) histological parameters in the individualized multidisciplinary management of PMP patients undergoing CRS and HIPEC. Future research should focus on incorporating molecular and genetic biomarkers to further refine patient selection and improve treatment outcomes. Full article

Objective: The aim of this thesis was to externally validate a predictive model of suboptimal surgery in advanced ovarian cancer, developed by doctors Escrig and Llueca. The model classifies patients pre-surgically to estimate the likelihood of incomplete cytoreductive surgery. Methods: A retrospective cohort comparison between two time periods was performed. Validation used a new cohort of 83 patients with advanced ovarian cancer, prospectively collected between 2017 and 2023 across five hospitals (experimental group). This group was compared with the original control cohort (2013–2016), which had served for model development. The predictive models (R3 and R4) are based on the Peritoneal Carcinomatosis Index (PCI) assessed by CT, laparoscopic PCI, and the presence of intestinal sub-obstruction. For model R4, intraoperative PCI was also included. Results: The experimental group had a lower rate of suboptimal cytoreduction compared with the control group (4.8% vs. 13.8%; p = 0.049). Significant differences were observed in ascites (49.4% vs. 27.5%; p = 0.002), and no patient in the experimental group presented intestinal sub-obstruction (0% vs. 8%; p = 0.002). Although at least 13 suboptimal surgeries were expected for validation, only four occurred. The predictive models did not classify any of these four cases as high risk, instead categorizing them as low or intermediate risk. Conclusions: Statistical external validation could not be performed due to event scarcity. This reduced incidence is attributed to selection bias: highly experienced surgical teams from participating centres likely applied criteria similar to those of the model, referring high risk patients (e.g., with intestinal sub-obstruction) to neoadjuvant therapy and thus avoiding suboptimal primary surgeries. Although direct validation was not possible, the findings indirectly suggest that the model is effective in guiding patient selection and improving surgical outcomes. Full article

Background/Objectives: Emergency surgery for complicated colon cancer carries high morbidity and mortality, largely driven by systemic inflammation and organ dysfunction. This study aims to investigate the predictive value of preoperative inflammatory biomarkers for postoperative outcomes. Methods: We retrospectively analyzed 219 patients undergoing emergency surgery for complicated colon cancer. Patients were classified as uncomplicated (n = 164) or complicated (Clavien–Dindo ≥ IIIA; n = 55). Preoperative clinical data, comorbidity indices, laboratory values, and inflammatory markers: C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were assessed. Logistic regression and ROC (Receiver Operating Characteristic) curves analyses identified predictors of Clavien Dindo complications graded as IIIA or higher, anastomotic leak (AL), and in-hospital mortality. Results: Most patients included in the study were males (75.02%), with a mean age of 69.63 (±11.54) years. Patients included in the complicated group had higher comorbidity burden, ASA (American Society of Anesthesiologists) grade, rates of diabetes, organ failure, and systemic inflammatory response. All inflammatory biomarkers were significantly elevated in the complicated group (p < 0.001). CRP (>62.8 mg/dL), NLR (>6.89), and PLR (>334.2) showed good discrimination for Clavien Dindo complications graded as IIIA or higher, with AUC (area under curve) ranging from 0.726 to 0.799. A multivariable model including Charlson Comorbidity Index (CCI), CRP, PLR, and diabetes predicted Clavien–Dindo ≥ IIIA complications with excellent accuracy (AUC 0.870). PLR, creatinine, and diabetes independently predicted AL (AUC 0.834). Mortality (20.5%) was strongly associated with peritonitis, CRP, and NLR (AUC 0.891). Conclusions: Preoperative inflammatory biomarkers, combined with comorbidity and renal function, reliably predict adverse outcomes after emergency colon cancer surgery. Multivariate models may be useful for early risk stratification and support individualized perioperative management. Full article

Background/Objectives: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may modify the prognostic impact of established clinical and surgical factors in advanced ovarian cancer. A retrospective study was conducted to identify independent predictors of survival, recurrence patterns and major postoperative complications in the HIPEC setting. Methods: In total, 265 women with advanced-stage ovarian cancer operated on between 2015 and 2019 were included. Patients were treated with CRS, with or without HIPEC. Patients’ characteristics, oncological and follow-up information were collected. Results: In total, 62.3% underwent primary CRS, and 39.2% received HIPEC, with complete or near-complete cytoreduction (CC-0/1) achieved in 85.6%. Major complications (≥grade III) were recorded in 16.6% of the patients. HIPEC, high peritoneal cancer index (PCI), and greater intraoperative blood loss were found to independently increase the odds of major postoperative complications, while prior surgery was the only independent predictor of local-regional recurrence. The median follow-up was 34 months, with a median progression-free (PFS) and overall survival (OS) of 26 and 77 months, respectively. Multivariable analysis identified systematic lymphadenectomy and serous histology as independent predictors for PFS and also for OS, with the addition of CC-3. Survival analysis with Kaplan–Meier curves revealed that CRS plus HIPEC was associated with significantly better OS, but not PFS, compared with CRS alone. Conclusions: Systematic lymphadenectomy, serous histology, and absence of macroscopic gross residual disease emerge as key independent favorable prognostic factors in the HIPEC era, while prior surgery adversely affects loco-regional control. CRS plus HIPEC improved OS in this specific regimen’s perfusion protocol but was associated with higher major postoperative complications, underscoring the need for careful patient selection. Full article

(1) Background: Hudson first described the procedure that includes en-block removal of an ovarian tumor fixed in the pelvis with the whole pelvic peritoneum and invaded surrounding structures. However, sometimes pelvic peritonectomy (PP) with or without shaving of the bowel serosa is not enough to achieve complete cytoreduction, and en-block rectosigmoid resection (RR) is necessary. This study aims to investigate the impact of bowel surgery on survival rates and morbidity of patients with advanced ovarian cancer. (2) Methods: We retrospectively analyzed patients with advanced ovarian cancer with cul-de-sac involvement that underwent debulking surgery at the 1st Department of Obstetrics—Gynecology of “Papageorgiou” General Hospital, from 2017–2022. The primary outcomes were the survival rates and morbidity between PP and RR. (3) Results: A total of 93 patients met the inclusion criteria. Patients were categorized into two groups: Group A (34 patients) with RR and Group B (59 patients) with PP. There was no statistically significant difference in the majority of patients’ characteristics and oncological outcomes. On the other hand, patients with RR had a significantly higher surgical complexity score (SCS), peritoneal cancer index (PCI), ICU admission, rate of postoperative complications, longer surgery duration and hospital stay. When comparing the duration of surgery, the RR group has significantly higher operation time during primary compared to interval debulking surgery. Concerning survival rates, there was no significant difference in progression-free (PFS) (p = 0.22) and overall survival (OS) (p = 0.85) between the two groups, while residual disease and postoperative complications were identified as independent prognostic factors for PFS and OS; (4) Conclusions: The modified Hudson procedure with RR is a safe and reproductible technique, but when complete gross resection can be achieved with PP, this technique is preferred in order to avoid increased patient’s morbidity. Full article

Background/Objectives: Peritoneal surface metastases (PSMs) from colorectal cancer have high rates of peritoneal recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Prior studies dichotomize peritoneal recurrence into “early” and “late,” limiting insight into how clinicopathologic factors influence recurrence timing. This study aimed to identify predictors of peritoneal recurrence and quantify their continuous association with time to recurrence following CRS/HIPEC. Methods: Patients undergoing CC-0 CRS/HIPEC for colorectal PSM from 2018 to 2024 were identified from a prospectively maintained database. The primary outcome was peritoneal surface recurrence. Variables included peritoneal cancer index (PCI), tumor location, histology, HIPEC regimen, and KRAS/BRAF/SMAD4 status. Factors with p < 0.10 on univariable analysis were entered into multivariable logistic regression (recurrence: yes/no) and linear regression (time to recurrence). Results: Among 133 patients, 64 (48.1%) developed peritoneal recurrence. Median time to recurrence was 41.4 weeks (IQR 24.9–74.0), and PCI was higher among those who recurred (median 11.0 vs. 5.0, p < 0.01). Neither tumor stage, histology, intraperitoneal chemotherapy agent, nor molecular alterations were associated with increased risk of peritoneal recurrence. When controlling for PCI, right- and sigmoid-colon primaries independently predicted peritoneal recurrence compared to all other locations without influence on recurrence timing (right: OR 7.18; sigmoid: OR 6.54; p < 0.01). Among patients who recurred, each one-point increase in PCI corresponded to a 2.43-week earlier relapse (p < 0.01). Conclusions: Nearly half of patients with colorectal PSM recurred despite complete CRS/HIPEC. Tumor location predicted peritoneal recurrence, while PCI independently shortened time to relapse. Modeling PCI as a continuous predictor refines postoperative risk stratification and may inform individualized surveillance strategies. Full article

Background: The introduction of tyrosine kinase inhibitors has revolutionised the treatment of gastrointestinal stromal tumours (GISTs), yet the role of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal GISTosis remains controversial. Methods: A retrospective analysis was conducted on patients with peritoneal GISTosis who underwent CRS plus HIPEC in an 18-year period. We analysed the clinicopathological characteristics and evaluated the perioperative and long-term outcomes based on the extent of disease (peritoneal cancer index, PCI), the resection (completeness of cytoreduction score) and the IM-administration. The survival factors were also analysed and the Kaplan–Meier estimator to model and estimate overall (OS) and progression-free survival (PFS). The median follow-up period was 72 months (range, 12–146). Results: A total of 25 patients (M:F = 15:10) with a median age of 57 years (range, 32–69) underwent CRS with HIPEC for peritoneal GIST metastases, detected either synchronously (n = 11) or metachronously (n = 14). The media PCI score was 9 (range, 4–20) and complete cytoreduction was achieved in 80%. Grade III complications were observed in two patients, whereas there was no postoperative mortality. Neoadjuvant imatinib-mesylate (IM) therapy was administered in 60% of patients who detected with metachronous metastases (n = 8/14), whereas adjuvant IM therapy was administered in 19 of 25 patients. Median OS was 62 months (95% CI = 22.8–101.2). Median OS and DFS for patients with PCI scores ≤ 10 were significantly longer compared to those with PCI scores > 10 (p = 0.009 and p = 0.024, respectively). Patients with CC scores of 0–1 had a significantly longer OS compared to those with CC scores of 2 (p = 0.005) and 3 (p = 0.002) and longer PFS compared to those with CC scores of 3 (p = 0.005). The need for imatinib did not significantly impact OS (p = 0.240) or PFS (p = 0.243). Conclusions: CRS combined with HIPEC shows promising results in peritoneal GISTosis, especially in patients with lower PCI and CC scores. Until larger studies validate its safety and efficacy, it should be primarily performed in expert hands in specialised peritoneal surface oncology centres. Full article

Background: Accurate preoperative staging is the cornerstone of therapeutic decision-making in gastric cancer (GC), yet standard modalities often fail to capture the full extent of disease, particularly in diffuse and poorly cohesive histotypes. This review aims to provide a comprehensive update on diagnostic imaging for GC, evaluating the established roles of CT, EUS, and PET/CT alongside the emerging capabilities of Magnetic Resonance Imaging (MRI) and Artificial Intelligence (AI). Methods: A structured narrative review was conducted by searching indexed biomedical databases for studies published between 2015 and 2024. A structured literature search screening process identified 410 relevant studies focusing on T, N, and M staging accuracy, quantitative imaging biomarkers, and radiomics. Results: While Multidetector CT remains the universal first-line modality, its sensitivity declines in infiltrative tumors and low-volume peritoneal carcinomatosis. EUS retains superiority for early (T1-T2) lesions but may offer limited value in advanced stages. Conversely, MRI (leveraging diffusion-weighted imaging (DWI) and multiparametric protocols) indicates superior soft-tissue contrast, potentially outperforming CT in the assessment of serosal invasion, nodal involvement, and occult peritoneal metastases. Furthermore, emerging fibroblast activation protein inhibitor (FAPI) PET tracers show promise in overcoming the limitations of FDG in mucinous and diffuse GC. Finally, radiomics and deep learning models are providing novel quantitative biomarkers for non-invasive risk stratification. Conclusions: Contemporary GC staging requires a tailored, multimodality approach. Evidence supports the increasing integration of MRI and quantitative imaging into clinical workflows to overcome the limitations of conventional techniques and support precision oncology. Full article

Background/Objectives: Cytoreduction status is a critical prognostic factor in ovarian cancer, yet preoperative selection of patients suitable for primary debulking surgery and accurate prediction of surgical outcome remain challenging. This study aimed to evaluate the prognostic ability of MRI-based Fagotti score and Peritoneal Cancer Index (PCI) for predicting resectability of peritoneal disease in ovarian cancer patients. Methods: This was a prospective single-center observational study. Patients with suspected primary ovarian cancer who underwent preoperative MRI of the abdomen and pelvis with a dedicated protocol were considered. MRI-based Fagotti score and PCI were determined by two readers independently, using a combination of T2W, Diffusion-Weighted Imaging (DWI), and contrast-enhanced T1W sequences. In cases of discordance, a third radiologist reviewed the scans and consensus was reached. ROC analysis and logistic regression were used to evaluate prognostic performance. The reference standard to predict resectability was optimal cytoreduction defined as residual disease ≤1 cm. Results: Forty-six women with epithelial ovarian cancer (mean age 56.3 ± 2.6 years) who underwent preoperative MRI, followed by laparoscopy and/or laparotomy, were included in the study. Both MRI-based Fagotti score and PCI showed high predictive value for predicting resectability (AUC 0.92 and 0.94, respectively). Optimal cut-offs were ≤6 for Fagotti score and ≤20 for PCI. Patients with scores below these thresholds had >60-fold (Fagotti) and >100-fold (PCI) increased odds for successful primary cytoreduction (p < 0.001). Conclusions: MRI-based Fagotti score and PCI may serve as powerful noninvasive predictors of surgical outcome in ovarian cancer. MRI may reliably guide treatment decisions, reducing unnecessary laparotomies and optimizing patient selection. Full article