Prediction of Platinum-based Chemotherapy Response in Advanced High-grade Serous Ovarian Cancer: ADC Histogram Analysis of Primary Tumors

•Solid components of high-grade serous ovarian cancer were more clinically significant for histogram analysis. •Histogram-derived parameters were significant for predicting platinum sensitivity. •Tumors with higher apparent diffusion coefficient mean were more likely to be platinum-sensitive. •Tumors with lower skewness and kurtosis were more likely to be platinum-sensitive. •Skewness was an independent risk factor for platinum resistance. Rationale and Objectives To investigate the feasibility of apparent diffusion coefficient (ADC) histogram analysis of primary advanced high-grade serous ovarian cancer (HGSOC) to predict patient response to platinum-based chemotherapy. Materials and Methods A total of 70 patients with 102 advanced stage HGSOCs (International Federation of Gynecology and Obstetrics (FIGO) stages III-IV) who received standard treatment of primary debulking surgery followed by the first line of platinum-based chemotherapy were retrospectively enrolled. Patients were grouped as platinum-resistant and platinum-sensitive according to whether relapse occurred within 6 months. Clinical characteristics, including age, pretherapy CA125 level, International Federation of Gynecology and Obstetrics stage, residual tumor, and histogram parameters derived from whole tumor and solid component such as ADCmean; 10th, 20th, 25th, 30th, 40th, 50th, 60th, 70th, 75th, 80th, 90th percentiles; skewness and kurtosis, were compared between platinum-resistant and platinum-sensitive groups. Results No significantly different clinical characteristics were observed between platinum-sensitive and platinum-resistant patients. There were no significant differences in any whole-tumor histogram-derived parameters between the two groups. Significantly higher ADCmean and percentiles and significantly lower skewness and kurtosis from the solid-component histogram parameters were observed in the platinum-sensitive group when compared with the platinum-resistant group. ADCmean, skewness and kurtosis showed moderate prediction performances, with areas under the curve of 0.667, 0.733 and 0.616, respectively. Skewness was an independent risk factor for platinum resistance. Conclusion Pretreatment ADC histogram analysis of primary tumors has the potential to allow prediction of response to platinum-based chemotherapy in patients with advanced HGSOC. To investigate the feasibility of apparent diffusion coefficient (ADC) histogram analysis of primary advanced high-grade serous ovarian cancer (HGSOC) to predict patient response to platinum-based chemotherapy. A total of 70 patients with 102 advanced stage HGSOCs (International Federation of Gynecology and Obstetrics (FIGO) stages III-IV) who received standard treatment of primary debulking surgery followed by the first line of platinum-based chemotherapy were retrospectively enrolled. Patients were grouped as platinum-resistant and platinum-sensitive according to whether relapse occurred within 6 months. Clinical characteristics, including age, pretherapy CA125 level, International Federation of Gynecology and Obstetrics stage, residual tumor, and histogram parameters derived from whole tumor and solid component such as ADCmean; 10th, 20th, 25th, 30th, 40th, 50th, 60th, 70th, 75th, 80th, 90th percentiles; skewness and kurtosis, were compared between platinum-resistant and platinum-sensitive groups. No significantly different clinical characteristics were observed between platinum-sensitive and platinum-resistant patients. There were no significant differences in any whole-tumor histogram-derived parameters between the two groups. Significantly higher ADCmean and percentiles and significantly lower skewness and kurtosis from the solid-component histogram parameters were observed in the platinum-sensitive group when compared with the platinum-resistant group. ADCmean, skewness and kurtosis showed moderate prediction performances, with areas under the curve of 0.667, 0.733 and 0.616, respectively. Skewness was an independent risk factor for platinum resistance. Pretreatment ADC histogram analysis of primary tumors has the potential to allow prediction of response to platinum-based chemotherapy in patients with advanced HGSOC.