High-Grade Serous Ovarian Cancer: Associations between BRCA Mutation Status, CT Imaging Phenotypes, and Clinical Outcomes

Abstract

Purpose To investigate the associations between BRCA mutation status and computed tomography (CT) phenotypes of high-grade serous ovarian cancer (HGSOC) and to evaluate CT indicators of cytoreductive outcome and survival in patients with BRCA-mutant HGSOC and those with BRCA wild-type HGSOC. Materials and Methods This HIPAA-compliant, institutional review board-approved retrospective study included 108 patients (33 with BRCA mutant and 75 with BRCA wild-type HGSOC) who underwent CT before primary debulking. Two radiologists independently reviewed the CT findings for various qualitative CT features. Associations between CT features, BRCA mutation status, cytoreductive outcome, and progression-free survival (PFS) were evaluated by using logistic regression and Cox proportional hazards regression, respectively. Results Peritoneal disease (PD) pattern, presence of PD in gastrohepatic ligament, mesenteric involvement, and supradiaphragmatic lymphadenopathy at CT were associated with BRCA mutation status (multiple regression: P < .001 for each CT feature). While clinical and CT features were not associated with cytoreductive outcome for patients with BRCA-mutant HGSOC, presence of PD in lesser sac (odds ratio [OR] = 2.40) and left upper quadrant (OR = 1.19), mesenteric involvement (OR = 7.10), and lymphadenopathy in supradiaphragmatic (OR = 2.83) and suprarenal para-aortic (OR = 4.79) regions were associated with higher odds of incomplete cytoreduction in BRCA wild-type HGSOC (multiple regression: P < .001 each CT feature). Mesenteric involvement at CT was associated with significantly shorter PFS for both patients with BRCA-mutant HGSOC (multiple regression: hazard ratio [HR] = 26.7 P < .001) and those with BRCA wild-type HGSOC (univariate analysis: reader 1, HR = 2.42, P < .001; reader 2, HR = 2.61; P < .001). Conclusion Qualitative CT features differed between patients with BRCA-mutant HGSOC and patients with BRCA wild-type HGSOC. CT indicators of cytoreductive outcome varied according to BRCA mutation status. Mesenteric involvement at CT was an indicator of significantly shorter PFS for both patients with BRCA-mutant HGSOC and those with BRCA wild-type HGSOC. RSNA, 2017 Online supplemental material is available for this article.

Integrative radiogenomics for virtual biopsy and treatment monitoring in ovarian cancer

“…Patients with BRCA mutations tend to have better responses to chemotherapy due to the higher platinum sensitivity, and this improves their overall survival when compared to BRCA wild-type patients [ 50 , 51 ]. Using features from CT in a dataset with 108 HGSOC patients, a higher likelihood of having mutant BRCA was found to be related with nodular pelvic disease and the presence of disease in the gastrohepatic ligament, whilst infiltrative pelvic disease, mesenteric presence and supradiaphragmatic lymphadenopathy were related with decreased likelihood of BRCA mutation [ 42 ]. Additionally, the same study reported the higher likelihood of incomplete resection in BRCA wild-type HGSOC in cases with mesenteric involvement and lymphadenopathy in supradiaphragmatic, as well as shorter PFS in both mutant and wild-type BRCA patients with suprarenal para-aortic regions and pelvic disease presence in the lesser sac and left upper quadrant and the mesenteric involvement relationship [ 42 ].…”

“…CLOVAR refers to the Classification of Ovarian Cancer proposed in [ 41 ] Method Ref. Patients Imaging Level of association Biological correlate Results Regular association [ 42 ] 108 CT Genomics BRCA mutation Nodular pelvic disease and the presence of pelvic disease in the gastrohepatic ligament associated with high likelihood of BRCA. Infiltrative pelvic disease, mesenteric presence and supradiaphragmatic lymphadenopathy were related with less likelihood of BRCA mutation.…”

A mathematical-descriptor of tumor-mesoscopic-structure from computed-tomography images annotates prognostic- and molecular-phenotypes of epithelial ovarian cancer

“…“Radiomics” quantifies mesoscopic tumor phenotype from anatomic or functional images by defining tumor spatial complexity—including first and higher order statistics, fractal and shape features—generating disease features not appreciated by the naked eye 1–3 . The development of a radiomics approach for disease phenotyping, using routine pre-surgical computed tomography (CT), as an extension of current imaging semantics is therefore promising 4–6 .…”

A Computed Tomography-Based Radiomic Prognostic Marker of Advanced High-Grade Serous Ovarian Cancer Recurrence: A Multicenter Study

“…Contrast enhanced computed tomography (CT), a routinely used diagnostic tool, provides a non-invasive and low-cost method for extracting HGSOC prognostic information (8). Radiomics, a subset of the field of medical imaging research, has progressed dramatically in recent years, enabling comprehensive expression of tumor heterogeneity and more advanced prognostic applications (9).…”