Therapeutic Outcomes and Biomarker Potential of CDKL3 of Neoadjuvant Chemotherapy in Patients With Stage IIIC Versus Stage IV Epithelial Ovarian Cancer

Epithelial ovarian cancer (EOC) remains one of the most lethal gynecological malignancies. Although treatment options for newly diagnosed advanced EOC include primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), the comparative effectiveness of these strategies remains uncertain across different disease stages. We conducted a retrospective analysis of 297 patients with EOC whose initial treatment strategy was guided by predicted primary resectability using the Suidan model. We assessed their progression-free survival (PFS) and overall survival outcomes stratified by FIGO stage and treatment approach (PDS v NACT-IDS). We also explored molecular markers associated with prognosis and chemotherapy response. Our analysis revealed that patients with stage IIIC EOC had improved survival outcomes with PDS, whereas those with stage IV disease benefited more from NACT-IDS. Furthermore, CDKL3 was identified as a gene associated with poor prognosis and platinum resistance, potentially contributing to the observed differential survival patterns across stages. These findings suggest that FIGO stage provides additional value in guiding the selection of patients with EOC who may benefit from neoadjuvant chemotherapy. CDKL3 may serve as a promising biomarker for treatment stratification and a therapeutic target to overcome chemoresistance.