Prognostic Nomogram for Ovarian Cancer Patients on First‐Line Maintenance Therapy With PARP Inhibitors: A Retrospective Cohort Study

OBJECTIVE: To develop and validate a prognostic nomogram that integrates clinical variables and biomarker statuses for predicting progression-free survival (PFS) and overall survival (OS) in patients with advanced epithelial ovarian cancer (OC) receiving first-line poly (ADP-ribose) polymerase inhibitor (PARPi) maintenance therapy. METHODS: Clinical data from 145 OC patients who received first-line PARPi maintenance therapy from August 2018 to May 2024 were retrospectively analyzed. Univariate and multivariate regression analyses were performed to identify the predictive factors. A nomogram was constructed using a multivariate Cox regression model. RESULTS: Patients with OC who received first-line PARPi maintenance treatment showed improved PFS (median PFS: 48.53 months) and OS. Cox regression analysis identified several independent prognostic factors for prolonged PFS, including BRCA mutations, R0 resection (no residual disease), FIGO stage III (vs. IV), and a higher CA-125 elimination rate constant (KELIM) score (KELIM > 1). Additionally, BRCA mutations and younger age were significant predictors of better OS. Analysis of subsequent treatment in patients who experienced recurrence revealed that platinum-based second-line chemotherapy combined with bevacizumab improved outcomes, whereas a longer duration of PARPi therapy (> 12 months) appeared to be associated with poorer prognosis. CONCLUSION: This study establishes and validates the nomogram that integrates clinical factors (FIGO Stage, Residual Disease, and Age) with biomarkers (BRCA and KELIM) to predict outcomes in patients with advanced OC receiving First-Line PARPi maintenance therapy. Furthermore, our finding suggest that an extended duration of PARPi treatment may be a risk factor for subsequent treatment.