The degree of T-cell infiltration has been suggested as an important prognostic biomarker for colorectal cancer (CRC) patients, regardless of other clinical and/or pathological factors. In this study, we analyzed tumor-infiltrating lymphocyte (TIL) counts of CRC using Lunit SCOPE IO, an artificial intelligence (AI)-powered whole slide image (WSI) software analyzer. Our aim was to analyze the prognostic significance of AI-powered TIL analysis in CRC.
Lunit SCOPE IO was trained and validated with a 2.8 x 109 micrometer2 area and 5.9 x 106 TILs from 3,166 H&E Whole-Slide Images (WSI) of multiple cancer types, annotated by 52 board-certified pathologists. The Inflamed Score (IS) was defined as the proportion of all tumor-containing 1 mm2-size tiles within a WSI classified as being of the inflamed immune phenotype (high TIL density within cancer epithelium). H&E images, sequencing data and survival data of stage I-III CRC patients from The Cancer Genome Atlas (TCGA) were utilized for this analysis.
Stage I-III CRC samples (n = 461) with clinical data were analyzed. The median of IS was 8.56 (IQR 3.74-18.39). IS showed moderate positive correlations with CD8A (rs = 0.422, p < 0.001) and CD3G (rs = 0.377, p < 0.001) expression levels but weaker positive correlations with regulatory T cells (rs = 0.162, p < 0.001), TH1 (rs = 0.209, p < 0.001) or TH2 cell proportions (rs = 0.128, p = 0.006). The IS was higher in CMS1 group compared to CMS 2-4 groups (median 18.49 vs. 6.90, p < 0.001). No significant differences in IS was observed across TNM stages. The recurrence-free survival of the patients with IS higher than third quartile (>= 18.39) were significantly longer compared to the lower group (p = 0.034, HR 0.540, 95% CI 0.306-0.954). The same outcome was observed in cases with MSS tumors (p = 0.023, HR 0.380, 95% CI 0.165-0.877).
AI-powered analysis of WSI can provide prognostic information in stage I-III CRC patients. Further development of AI-powered TIL analysis including the spatial
C. Park1, Y. Lim2, S. Song2, S. Ahn2, J. Ryu2, H. Song2, M. Ma2, S. Park2, S. Pereira2, B.J. Aum2, S. Shin2, S. Cho2, K. Paeng2, D. Yoo2, W. Jung2, C. Ock2
1 Internal Medicine, Seoul National University Hospital, 03080 - Seoul/KR
2 Oncology Group, Lunit Inc., 06241 - Seoul/KR