mpMRI-based habitat analysis for predicting prognoses in patients with high-grade serous ovarian cancer: a multicenter study

Purpose To evaluate the value of multiparametric MRI (mpMRI)-based habitat analysis for predicting prognoses in patients with high-grade serous ovarian cancer (HGSOC), and to develop combined models by integrating habitat analysis with clinical predictors. Methods This retrospective study included 503 HGSOC patients from four centers. A K-means algorithm was used to identify voxel clusters and generate habitats on mpMRI. Radiomics features were extracted from each habitat sub-region. After feature selection, habitat models were developed to predict overall survival (OS) and progression-free survival (PFS). Cox regression analyses were performed to identify clinical predictors and construct clinical models. Combined models were developed by integrating habitat signatures with clinical predictors. Model performance was evaluated using C-index and time-dependent receiver operating characteristic area under the curves (AUCs). Results Compared with the clinical models (OS: 0.713 and 0.695; PFS: 0.727 and 0.700) and habitat models (OS: 0.707 and 0.672; PFS: 0.627 and 0.641), the combined models integrating habitat features and clinical independent predictors such as neoadjuvant chemotherapy (OS: 0.752 and 0.745; PFS: 0.784 and 0.754) achieved the highest C-indexes for predicting OS and PFS in the internal validation cohort and external test cohort. The combined models also achieved the highest AUCs in all cohorts. Conclusion The habitat models based on mpMRI demonstrated potential value in predicting the prognoses of HGSOC patients, but no significant advantages over the clinical models. The combined models were expected to improve the prognoses from the level of individual clinical characteristics and habitat features reflecting intratumoral heterogeneity.