CT影像特征预测高级别浆液性卵巢癌同源重组缺陷及预后
回顾性纳入125例III-IV期高级别浆液性卵巢癌患者，术前增强CT评估卵巢病灶形态及腹膜播散特征。HRD阳性与结节状腹膜播散模式及无小肠系膜受累相关；联合两特征的CT分类预测HRD的敏感度40.0%、特异度88.0%、准确率68.8%，且与PFS显著相关（p=0.022）。
要点
- 结节状腹膜播散且无小肠系膜受累提示HRD阳性可能。
- 联合两特征的CT分类预测HRD特异度88.0%，敏感度40.0%。
- 该CT分类与无进展生存期显著相关（p=0.022）。
关键影像表现/征象
- HRD阳性与结节状腹膜播散模式显著相关。
- HRD阳性与无小肠系膜受累显著相关。
- 上腹部播散在BRCA野生型病例中更常见。
- 腹膜播散模式与BRCA突变状态无显著关联。
诊断标准与关键数值
- 联合结节状PD模式和无小肠系膜受累的CT分类预测HRD阳性：敏感度40.0%，特异度88.0%，准确率68.8%。
- 该CT分类与PFS显著相关（p=0.022）。
临床应用与阅片要点
- 阅片时可关注腹膜播散呈结节状且无小肠系膜受累者，提示HRD阳性可能。
- 该CT分类特异度高但敏感度低，阳性提示HRD但阴性不能排除。
- 上腹部播散更常见于BRCA野生型，可辅助基因状态判断。
局限性
- 回顾性研究设计。
- 单中心样本量有限（125例）。
- CT分类敏感度较低（40.0%）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
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.
引用
- Kojo S, Takada A, Yokota H, et al. CT imaging features as predictors of homologous recombination deficiency and prognosis in high-grade serous ovarian cancer. Abdom Radiol (NY). 2026. PMID: 41981272. doi:10.1007/s00261-026-05459-4
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。