Kumar A, Wang C, Sheedy SP, McCauley BM, Winham SJ, Ramus SJ, Anglesio MS, Kim B, Torres D, Keeney GL, Cliby WA, Goode EL
Abstract
Objective. We sought to determine the predictive value of combining tumor molecular subtype and comput-erized tomography (CT) imaging for surgical outcomes after primary cytoreductive surgery in advanced stage high-grade serous ovarian cancer (HGSOC) patients. Methods. We identified 129 HGSOC patients who underwent pre-operative CT imaging and post-operative tumor mRNA profiling. A continuous CT-score indicative of overall disease burden was defined based on six im-aging measurements of anatomic involvement. Molecular subtypes were derived from mRNA profiling of chemo-naive tumors and classified as mesenchymal (MES) subtype (36%) or non-MES subtype (64%). Fischer exact tests and multivariate logistic regression examined residual disease and surgical complexity. Results. Women with higher CT-scores were more likely to have MES subtype tumors (p = 0.014). MES sub-types and a high CT-score were independently predictive of macroscopic disease and high surgical complexity. In multivariate models adjusting for age, stage and American Society of Anesthesiologists (ASA) score, patients with a MES subtype and high CT-score had significantly elevated risk of macroscopic disease (OR = 26.7, 95% CI = [6.42, 187]) and were more likely to undergo high complexity surgery (OR = 9.53, 95% CI = [2.76, 40.6], com-pared to patients with non-MES tumor and low CT-score. Conclusion. Preoperative CT imaging combined with tumor molecular subtyping can identify a subset of women unlikely to have resectable disease and likely to require high complexity surgery. Along with other clinical factors, these may refine predictive scores for resection and assist treatment planning. Investigating methods for pre-surgical molecular subtyping is an important next step. (c) 2022 Elsevier Inc. All rights reserved.
