Abstract 1721: Spatial distribution of immune cells as quantitative prognosis indicator in hepatocellular carcinoma
Authors: Lee Hongseok , Kim Kyungdoc , Kang Guhyun , Jung Kyu-Hwan , Lee Sunyoung S. 
Published: June 2022

Abstract
Background: We previously demonstrated that the analysis of the tumor microenvironment (TME) in histopathology images via tissue segmentation [1] and cell density in lymphocyte-rich area [2] impacts prognosis and treatment in hepatocellular carcinoma (HCC). Few biomarker models exist to prognosticate patients with HCC via the automated analysis of TME at the cellular level.
Methods: Clinical outcomes data and histopathology images of 351 patients with HCC were obtained from TCGA. We advanced a deep learning-based algorithm to analyze the tumor volume and spatial distribution of nuclei in TME. This was based on combination of two models: the PAIP2019 dataset was used for DenseNet-based HCC segmentation, which showed the performance of 0.8582 on the F1-score metric [3]; HoverNet-based cell detection model, which showed the performance of 0.654 on the binary PQ metric, annotated lymphocytes, macrophages, and neutrophils on the MonuSac dataset [4].
Results: The HCC segmentation model divided the TME into tumoral, marginal, and peritumoral areas by image processing. The marginal and peritumoral areas were defined as inner 50 um area and outer 100 um area from the estimated tumoral boundary, respectively. The ratios of neutrophils, lymphocytes, macrophages to the total cell count on marginal and peritumoral areas were calculated through integration of HCC segmentation and cell detection models. The proportions of leukocytes were subjected into Cox proportional hazard analysis. The results of Cox proportional hazard analysis calculated the proportions of macrophages and lymphocytes to other cells in the TME. The macrophage proportion on the peritumoral area was a significant prognostic indicator showing Log(hazard ratio) (-2.42 ± 2.14, p=0.026). The lymphocyte proportion on both areas of the peritumor and margins showed significant Log(hazard ratio) (-1.70 ± 1.61, p=0.042).
Conclusions: The retrospective analysis of the TME using deep learning-assisted algorithm combining tissue segmentation and cell detection models reveals that the ratio of lymphocytes and macrophages in the peri-tumoral areas of HCC TME significantly impact prognosis. Further analyses in the prospective studies may provide more information about cellular biomarkers.
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[2] Park et al. Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021) 4107-4107
[3] Kim, Yoo Jung, Jang, Hyungjoon, Lee, Kyoungbun et al. Medical Image Analysis 67 (2021): 101854.
[4] Verma, Ruchika. IEEE Transactions on Medical Imaging 39 (2020): 1380-1391.
[5] Graham, Simon. Medical Image Analysis 58 (2019): 101563.
Citation Format: Hongseok Lee, Kyungdoc Kim, Guhyun Kang, Kyu-Hwan Jung, Sunyoung S. Lee. Spatial distribution of immune cells as quantitative prognosis indicator in hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1721.