Real-world longitudinal Tissue Microarray Platform within clinical routine for Ovarian Cancer: from Primary Surgery through Recurrence in a large Tertiary-Center Cohort

Abstract Purpose To establish a tissue microarray-linked clinical platform for epithelial ovarian cancer, benchmark it against established prognostic associations, and evaluate surgical outcome across recurrence landmarks. Methods This retrospective single-center cohort included 524 consecutive patients with epithelial ovarian cancer. Clinicopathologic, surgical, treatment, and time-to-event data were linked to tumor tissue, including recurrent samples from 50 patients, and to a patient-derived organoid biobank. Survival was estimated using Kaplan-Meier methods and analyzed using log-rank tests and Cox proportional hazards models. Results High-grade serous carcinoma accounted for 415/524 cases (79.2%). In the overall cohort, 411/524 patients (78.4%) had FIGO stage III–IV disease. Of these, 374/411 (91.0%) underwent primary surgery, with complete gross tumor resection achieved in 225/374 (60.2%).In this cohort, median progression-free survival was 26.4 months after complete gross tumor resection compared to 13.6 months after postoperative residual disease (p < 0.001), and median overall survival was 70.7 versus 21.9 months, respectively (p < 0.001). First-line platinum-based chemotherapy and bevacizumab maintenance were associated with improved outcome. Complete gross tumor resection at primary surgery remained associated with longer survival across the first, second, and third recurrence landmarks, and complete gross tumor resection at secondary cytoreductive surgery was also associated with longer survival after recurrence. Conclusion The platform integrates longitudinal clinical outcomes with systematically curated tumor tissue and functional models. Although the recurrence-landmark analyses are exploratory, this resource provides a detailed and clinically anchored foundation for biomarker research.