Abstract
Homologous recombination (HR) status plays a critical role in selecting advanced epithelial ovarian cancer (EOC) patients for poly (ADP-ribose) polymerase inhibitor (PARPi) therapy. This study aimed to develop a novel nomogram to predict prognosis in these patients in the era of precision medicine. We conducted a single-institute retrospective analysis on patients diagnosed with advanced EOC between January 2021 and January 2024. Clinicopathological factors, HR status, and PARPi use were evaluated for their association with survival outcomes. Multivariate Cox regression analysis identified independent predictors of progression-free survival (PFS), and a nomogram was constructed and validated using bootstrap resampling. Among 128 patients, PARPi maintenance therapy was administered after front-line chemotherapy to 43 patients as indicated. Multivariate analysis identified optimal surgery [hazard ratio 0.47, 95% confidence interval (CI) 0.27-0.83], CA-125 > 10.7 U/mL after front-line chemotherapy [hazard ratio 3.41, 95% CI 1.85-6.31], neoadjuvant chemotherapy [hazard ratio 2.55, 95% CI 1.32-4.91], and PARPi use [hazard ratio 0.22, 95% CI 0.12-0.42] as independent predictors of PFS. Patients with all favorable factors had a predicted 3-year PFS of 100%, compared to 0% for those with none. The nomogram demonstrated strong predictive accuracy, with a concordance index of 0.78, and calibration plots showed excellent agreement. Internal validation confirmed the reliability of the nomogram. Our findings indicate that HR-deficient patients who respond well to upfront optimal debulking surgery and chemotherapy (indicated by a post-treatment CA125 level below 10.7 U/mL) may experience excellent PFS when followed by PARPi maintenance. Our nomogram provides a dependable tool for personalized prognosis assessment, enabling clinicians to optimize treatment strategies in the era of precision medicine.