CT imaging features as predictors of homologous recombination deficiency and prognosis in high-grade serous ovarian cancer

PURPOSE: To investigate the association between preoperative CT imaging features and homologous recombination deficiency (HRD) status in patients with high-grade serous ovarian cancer (HGSOC), and to assess their prognostic implications. METHODS: This retrospective study included 125 patients with stage III-IV HGSOC who underwent preoperative contrast-enhanced CT and BRCA/HRD testing. CT features, including the morphology of ovarian lesions and the location or characteristics of peritoneal dissemination, were evaluated by radiologists who were blinded to the genetic status. Associations between CT features and BRCA/HRD status were evaluated using logistic regression. Kaplan-Meier analysis and multivariate Cox regression were used to evaluate associations with progression-free survival (PFS). RESULTS: Out of 125 patients (mean age, 62.5 +/- 10.7 years [standard deviation]), 75 patients were HRD-positive. HRD-positive status was significantly associated with a nodular PD pattern and absence of small bowel mesenteric involvement. A combined CT feature-based classification incorporating these two features yielded a sensitivity of 40.0%, specificity of 88.0%, and accuracy of 68.8% for predicting HRD positivity. This classification was also significantly associated with PFS (p = 0.022). In contrast, no significant association was observed between PD pattern and BRCA mutation status. Upper abdominal dissemination was more frequent in BRCA wild-type cases. CONCLUSION: CT imaging features were associated with HRD status and prognosis in HGSOC, and the proposed CT-based classification showed fair discriminatory performance.