Objective:? To explore the correlation between ultrasound blood flow parameters and pathological staging of tumors, prognosis of elderly patients with ovarian cancer. Methods: A retrospective analysis was performed on the clinical data of 150 elderly patients with ovarian cancer in the hospital between January 2020 and April 2024. According to different pathological staging of tumors, they were divided into stage I group (27 cases), stage II group (32 cases) and stage III-IV group (91 cases). All patients underwent ultrasound examination to compare ultrasound blood flow parameters [pulsation index (PI), resistance index (RI), peak systolic velocity (PSV)] among the three groups at admission. The relationship between PI and RI, PSV was analyzed by Spearman correlation analysis. All patients were followed up for 3-39 months (median follow-up time of 22 months) to record number of survival and death cases. PI, RI and PSV in patients with different prognosis were compared at admission. The predictive value of PI, RI and PSV for prognosis was analyzed by ROC curves. Results: The results of ultrasound examination showed that PI and RI were gradually increased in stage III-IV group, stage II group and? stage I group, while PSV was gradually decreased (P<0.05). Spearman correlation analysis showed that PI was positively correlated with RI, while negatively correlated with PSV (P<0.05). During follow-up, proportions of survival and death cases were 78.67% (118/150) and 21.33% (32/150), respectively. Compared with survival cases at admission, PI and RI were lower, while PSV was higher in death cases (P<0.05). The results of ROC curve analysis showed that PI (AUC=0.757), RI (AUC=0.750) and PSV (AUC=0.790) were of good predictive value for prognosis (P<0.05). Conclusion: Ultrasound blood flow parameters are related to pathological staging of tumors in elderly patients with ovarian cancer, which also have good prognostic value.