On the predictability of progression-free survival in ovarian cancer from NanoString gene expression data

In the treatment of high grade serous ovarian cancer (HGSC), patients initially diagnosed with unresectable tumors are first treated with neoadjuvant chemotherapy (NACT) to reduce tumor burden prior to surgery. Analysis of matched pre- and post- NACT samples from the same patients enables the investigation of chemotherapy impacts and the biomarkers of progression. Although the tumor immune microenvironment (TIME) has increasingly been recognized as critical in shaping the development and progression of HGSC, we lack a comprehensive understanding of how chemotherapy remodels the TIME. Previous studies have found evidence for a general inflammatory response post-NACT, despite inconsistencies regarding which differentially expressed genes and pathways are implicated. We combine matched NanoString gene expression data from multiple sources to create a large dataset of matched pre- and post- NACT samples (N=83, with 29 novel to this study) and investigate reproducibility. Further, we use machine learning methods to investigate whether patient progression-free survival (PFS) can be predicted from the observed impact of chemotherapy on the TIME as represented by the comprehensive set of NanoString features. We find overall low predictability of PFS from all NanoString features, suggesting that previous results may have been limited by small sample size effects and that larger datasets are needed to identify more generalizable and translatable findings. We identify a set of differential expression features that are the most important for predicting patient outcomes that can be validated in future computational and biological studies.