Association between CT-texture-derived tumor heterogeneity, outcomes, and BRCA mutation status in patients with high-grade serous ovarian cancer

PURPOSE: To assess the associations between inter-site texture heterogeneity parameters derived from computed tomography (CT), survival, and BRCA mutation status in women with high-grade serous ovarian cancer (HGSOC). MATERIAL AND METHODS: retrospective study of 88 HGSOC patients undergoing CT and BRCA mutation status testing prior to primary cytoreductive surgery. Associations between texture metrics – namely inter-site cluster variance (SCV), inter-site cluster prominence (SCP), inter-site cluster entropy (SE) – and overall survival (OS), progression-free survival (PFS) as well as BRCA mutation status were assessed. RESULTS: Higher inter-site cluster variance (SCV) was associated with lower PFS (p=0.006) and OS (p=0.003). Higher inter-site cluster prominence (SCP) was associated with lower PFS (p=0.02) and higher inter-site cluster entropy (SE) correlated with lower OS (p=0.01). Higher values of all three metrics were significantly associated with lower complete surgical resection status in BRCA negative patients (SE p=0.039, SCV p=0.006, SCP p=0.02), but not in BRCA positive patients (SE p=0.7, SCV p=0.91, SCP p=0.67). None of the metrics were able to distinguish between BRCA mutation carrier versus non-mutation carrier. CONCLUSION: The assessment of tumoral heterogeneity in the era of personalized medicine is important, as increased heterogeneity has been associated with distinct genomic abnormalities and worse patient outcomes. A radiomics approach using standard-of-care CT scans might have a clinical impact by offering a noninvasive tool to predict outcome and therefore improving treatment effectiveness. However, it was not able to assess BRCA mutation status in women with HGSOC.