Advertisement

Development of a prediction model for gross residual in high-grade serous ovarian cancer by combining preoperative assessments of abdominal and pelvic metastases and multiparametric MRI

Published:December 31, 2022DOI:https://doi.org/10.1016/j.acra.2022.12.019

      Rationale and Objectives

      To preoperatively predict residual tumor (RT) in patients with high-grade serous ovarian carcinoma (HGSOC) via a radiomic-clinical nomogram.

      Methods

      A total of 128 patients with advanced HGSOC were enrolled (training cohort: n=106; validation cohort: n=22). Serum cancer antigen-125 (CA125), serum human epididymis protein 4 (HE-4) level, and neutrophil-to-lymphocyte ratio (NLR) were obtained from the medical records. Metastases in abdomen and pelvis (MAP) of HGSOC patients was evaluated and scored based on preoperative abdominal and pelvic enhanced CT, MRI and/or PET-CT. A volume of interest (VOI) of each tumor was manually contoured along the boundary slice-by-slice. Radiomic features were extracted from the T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) images. Univariate and multivariate analyses were used to determine the independent predictors of RT status. Least absolute shrinkage and selection operator (LASSO) logistic regression was performed to select optimal features and construct radiomic models. A radiomic-clinical nomogram incorporating radiomic signature and clinical parameters was developed and evaluated in training and validation cohorts.

      Results

      MAP score (p = 0.002), HE-4 level (p = 0.001) and NLR (p = 0.008) were independent predictors of RT status. The final radiomic-clinical nomogram showed satisfactory prediction performance in training (AUC = 0.936), cross validation (AUC = 0.906) and separate validation cohorts (AUC = 0.900), and fitted well in calibration curves (p > 0.05). Decision curve further confirmed the clinical application value of the nomogram.

      Conclusion

      The proposed MRI-based radiomic-clinical nomogram achieved excellent preoperative prediction of the RT status in HGSOC.

      Key Words

      Abbreviations:

      ADC (apparent diffusion coefficient), AUC (Areas under the receiver operating characteristics curve), CA125 (cancer antigen-125), CI (Confidence interval), DWI (diffusion-weighted images), HE-4 (human epididymis protein 4), HGSOC (high-grade serous ovarian carcinoma), ICC (Intraclass correlation coefficient), LASSO (least absolute shrinkage and selection operator), MAP (Metastases in abdomen and pelvis), NLR (neutrophil-to-lymphocyte ratio), PDS (primary debulking surgery), ROC (Receiver operating characteristic), RT (residual tumor), VOI (volume of interest), T2WI (T2-weighted image)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Reference

        • Siegel RL
        • Miller KD
        • Jemal A
        Cancer statistics, 2017.
        CA Cancer J Clin. 2017; 67: 7-30
        • Sung H
        • Ferlay J
        • Siegel RL
        • et al.
        Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.
        CA Cancer J Clin. 2021; 71: 209-249
        • Wentzensen N
        • Poole EM
        • Trabert B
        • et al.
        Ovarian cancer risk factors by histologic subtype: An analysis from the Ovarian Cancer Cohort Consortium.
        J Clin Oncol. 2016; 34: 2888-2898
        • Webb PM
        • Jordan SJ
        Epidemiology of epithelial ovarian cancer.
        Best Pract Res Clin Obstet Gynaecol. 2017; 41: 3-14
        • Chi DS
        • Eisenhauer EL
        • Lang J
        • et al.
        What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)?.
        Gynecol Oncol. 2006; 103: 559-564
        • Chang SJ
        • Bristow RE
        • Ryu HS
        Impact of complete cytoreduction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer.
        Ann Surg Oncol. 2012; 19: 4059-4067
        • du Bois A
        • Reuss A
        • Pujade-Lauraine E
        • Harter P
        • Ray-Coquard I
        • Pfisterer J
        Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the ArbeitsgemeinschaftGynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d'Investigateurs Nationaux Pour les Etudes des Cancers de l'Ovaire (GINECO).
        Cancer. 2009; 115: 1234-1244
        • Fagotti A
        • Vizzielli G
        • Fanfani F
        • et al.
        Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience.
        Gynecol Oncol. 2013; 131: 341-346
        • Kehoe S
        • Hook J
        • Nankivell M
        • et al.
        Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial.
        Lancet. 2015; 386: 249-257
        • Vergote I
        • Trope CG
        • Amant F
        • et al.
        Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer.
        N Engl J Med. 2010; 363: 943-953
        • Ghirardi V
        • Moruzzi MC
        • Bizzarri N
        • et al.
        Minimal residual disease at primary debulking surgery versus complete tumor resection at interval debulking surgery in advanced epithelial ovarian cancer: A survival analysis.
        Gynecol Oncol. 2020; 157: 209-213
        • van de Vrie R
        • Rutten MJ
        • Asseler JD
        • et al.
        Laparoscopy for diagnosing resectability of disease in women with advanced cancer.
        Cochrane Database Syst Rev. 2019; 3CD009786
        • Harrison RF
        • Cantor SB
        • Sun CC
        • et al.
        Cost-effectiveness of laparoscopic disease assessment in patients with newly diagnosed advanced ovarian cancer.
        Gynecol Oncol. 2021; 161: 56-62
        • Passot G
        • Dumont F
        • Goere D
        • et al.
        Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE).
        Br J Surg. 2018; 105: 663-667
        • Qian L
        • Ren J
        • Liu A
        • et al.
        MR imaging of epithelial ovarian cancer: a combined model to predict histologic subtypes.
        Eur Radiol. 2020; 30: 5815-5825
        • Peng H
        • Dong D
        • Fang MJ
        • et al.
        Prognostic value of deep learning PET/CT-based radiomics: Potential role for future individual induction chemotherapy in advanced nasopharyngeal carcinoma.
        Clin Cancer Res. 2019; 25: 4271-4279
        • Zhang H
        • Mao Y
        • Chen X
        • et al.
        Magnetic resonance imaging radiomics in categorizing ovarian masses and predicting clinical outcome: A preliminary study.
        Eur Radiol. 2019; 29: 3358-3371
        • Suidan RS
        • Ramirez PT
        • Sarasohn DM
        • et al.
        A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer.
        Gynecol Oncol. 2014; 134: 455-461
        • Feng Z
        • Wen H
        • Jiang Z
        • et al.
        A triage strategy in advanced ovarian cancer management based on multiple predictive models for R0 resection: A prospective cohort study.
        J Gynecol Oncol. 2018; 29: e65
        • Qayyum A
        • Coakley FV
        • Westphalen AC
        • Hricak H
        • Okuno WT
        • Powell B
        Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer.
        Gynecol Oncol. 2005; 96: 301-306
        • Axtell AE
        • Lee MH
        • Bristow RE
        • et al.
        Multi-institutional reciprocal validation study of computed tomography predictors of suboptimal primary cytoredcution in patients with advanced ovarian cancer.
        J Clin Oncol. 2007; 25: 384-389
        • Li H
        • Zhang R
        • Li R
        • et al.
        Noninvasive prediction of residual disease for advanced high-grade serous ovarian carcinoma by MRI-based radiomic-clinical nomogram.
        Eur Radiol. 2021; 31: 7855-7864
        • Lee EYP
        • An H
        • Perucho JAU
        • et al.
        Functional tumour burden of peritoneal carcinomatosis derived from DWI could predict incomplete tumour debulking in advanced ovarian carcinoma.
        Eur Radiol. 2020; 30: 5551-5559
        • Gemer O
        • Gdalevich M
        • Ravid M
        • et al.
        A multicenter validation of computerized tomography models as predictors of non-optimal primary cytoreduction of advanced epithelial ovarian cancer.
        Eur J Surg Oncol. 2009; 35: 1109-1112
        • Suidan RS
        • Ramirez PT
        • Sarasohn DM
        • et al.
        A multicenter assessment of the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease at primary debulking for advanced epithelial ovarian cancer.
        Gynecol Oncol. 2017; 145: 27-31
        • van Griethuysen JJM
        • Fedorov A
        • Parmar C
        • et al.
        Computational radiomics system to decode the radiographic phenotype.
        Cancer Res. 2017; 77: e104-e107
        • Wright AA
        • Bohlke K
        • Armstrong DK
        • et al.
        Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical practice guideline.
        J Clin Oncol. 2016; 34: 3460-3473
        • Zheng LE
        • Qu JY
        • He F
        The diagnosis and pathological value of combined detection of HE4 and CA125 for patients with ovarian cancer.
        Open Med (Wars). 2016; 11: 125-132
        • Pinto MP
        • Balmaceda C
        • Bravo ML
        • et al.
        Patients inflammatory status and CD4+/CD8+ intraepithelial tumor lymphocyte infiltration are predictors of outcomes in high-grade serous ovarian cancer.
        Gynecol Oncol. 2018; 151: 10-17
        • Henriksen JR
        • Nederby L
        • Donskov F
        • et al.
        Prognostic significance of baseline T cells, B cells and neutrophil-lymphocyte ratio (NLR) in recurrent ovarian cancer treated with chemotherapy.
        J Ovarian Res. 2020; 13: 59
        • Dowdy SC
        • Mullany SA
        • Brandt KR
        • Huppert BJ
        • Cliby WA
        The utility of computed tomography scans in predicting suboptimal cytoreductive surgery in women with advanced ovarian carcinoma.
        Cancer. 2004; 101: 346-352
        • Memarzadeh S
        • Lee SB
        • Berek JS
        • Farias-Eisner R
        CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer.
        Int J Gynecol Cancer. 2003; 13: 120-124
        • Kang S
        • Kim TJ
        • Nam BH
        • et al.
        Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis.
        J Surg Oncol. 2010; 101: 13-17
        • Vorgias G
        • Iavazzo C
        • Savvopoulos P
        • et al.
        Can the preoperative Ca-125 level predict optimal cytoreduction in patients with advanced ovarian carcinoma? A single institution cohort study.
        Gynecol Oncol. 2009; 112: 11-15
        • Chi DS
        • Zivanovic O
        • Palayekar MJ
        • et al.
        A contemporary analysis of the ability of preoperative serum CA-125 to predict primary cytoreductive outcome in patients with advanced ovarian, tubal and peritoneal carcinoma.
        Gynecol Oncol. 2009; 112: 6-10
        • Wagner F
        • Hakami YA
        • Warnock G
        • Fischer G
        • Huellner MW
        • Veit-Haibach P
        Comparison of Contrast-Enhanced CT and [18F]FDG PET/CT Analysis Using Kurtosis and Skewness in Patients with Primary Colorectal Cancer.
        Mol Imaging Biol. 2017; 19: 795-803
        • Rizzo S
        • Botta F
        • Raimondi S
        • et al.
        Radiomics of high-grade serous ovarian cancer: association between quantitative CT features, residual tumour and disease progression within 12 months.
        Eur Radiol. 2018; 28: 4849-4859
        • Chitalia RD
        • Kontos D
        Role of texture analysis in breast MRI as a cancer biomarker: A review.
        J Magn Reson Imaging. 2019; 49: 927-938
        • Bertucci F
        • Birnbaum D
        Distant metastasis: not out of reach any more.
        J Biol. 2009; 8: 28