Prognostic value of a modified Immunoscore in patients with stage I - III resectable colon cancer

Ke Zhao; Xiaomei Wu; Zhenhui Li; Yingyi Wang; Zeyan Xu; Yajun Li; Lin Wu; Su Yao; Yanqi Huang; Changhong Liang; Zaiyi Liu

doi:10.21147/j.issn.1000-9604.2021.03.09

Prognostic value of a modified Immunoscore in patients with stage I - III resectable colon cancer

Chin J Cancer Res. 2021 Jun 30;33(3):379-390. doi: 10.21147/j.issn.1000-9604.2021.03.09.

Authors

Ke Zhao^{1

2}, Xiaomei Wu³, Zhenhui Li⁴, Yingyi Wang⁵, Zeyan Xu¹, Yajun Li¹, Lin Wu⁶, Su Yao⁷, Yanqi Huang^{1

8}, Changhong Liang¹, Zaiyi Liu¹

Affiliations

¹ Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
² School of Medicine, South China University of Technology, Guangzhou 510006, China.
³ Department of Radiology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.
⁴ Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming 650118, China.
⁵ Department of Radiology, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai 519000, China.
⁶ Department of Pathology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming 650118, China.
⁷ Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
⁸ the Second School of Clinical Medicine, Southern Medical University, Guangzhou 510080, China.

PMID: 34321834
PMCID: PMC8286894
DOI: 10.21147/j.issn.1000-9604.2021.03.09

Abstract

Objective: The Immunoscore method has proved fruitful for predicting prognosis in patients with colon cancer. However, there is still room for improvement in this scoring method to achieve further advances in its clinical translation. This study aimed to develop and validate a modified Immunoscore (IS-mod) system for predicting overall survival (OS) in patients with stage I-III colon cancer.

Methods: The IS-mod was proposed by counting CD3+ and CD8+ immune cells in regions of the tumor core and its invasive margin by drawing two lines of interest. A discovery cohort (N=212) and validation cohort (N=103) from two centers were used to evaluate the prognostic value of the IS-mod.

Results: In the discovery cohort, 5-year survival rates were 88.6% in the high IS-mod group and 60.7% in the low IS-mod group. Multivariate analysis confirmed that the IS-mod was an independent prognostic factor for OS [adjusted hazard ratio (HR)=0.36, 95% confidence interval (95% CI): 0.20-0.63]. With less annotation and computation cost, the IS-mod achieved performance comparable to that of the Immunoscore-like (IS-like) system (C-index, 0.676 vs. 0.661, P=0.231). The 2-category IS-mod using 47.5% as the threshold had a better prognostic value than that using a fixed threshold of 25% (C-index, 0.653 vs. 0.573, P=0.004). Similar results were confirmed in the validation cohort.

Conclusions: Our method simplifies the annotation and accelerates the calculation of Immunoscore method, thus making it easier for clinical implementation. The IS-mod achieved comparable prognostic performance when compared to the IS-like system in both cohorts. Besides, we further found that even with a small reference set (N≥120), the IS-mod still demonstrated a stable prognostic value. This finding may inspire other institutions to develop a local reference set of an IS-mod system for more accurate risk stratification of colon cancer.

Keywords: Immunoscore; colon cancer; digital pathology; overall survival; whole-slide image.