European Radiology: How can imaging be used to assess intratumoral immune status in non-small cell lung cancer?

According to statistics, non-small cell lung cancer (NSCLC) accounts for about 85%
of lung cancers.
Although the American Joint Commission on Cancer (AJCC) tumor-lymph node-metastasis (TNM) staging system provides reliable risk stratification for routine prognosis and treatment decisions, there is considerable room for
improvement.

There is growing evidence that the evolution of cancer depends largely on the complex tumor immune microenvironment (TIME)
in which it operates.
As one of the important components of TIME, the prognostic role of tumor-infiltrating immune cells has been thoroughly studied in various tumors, and emerging data have confirmed its superiority
over the classical TNM staging system.

At this stage, a non-invasive method is still needed in clinical practice to assess the intratumoral immune status
of NSCLC.
A study published in the journal European Radiology uses a new radiomics approach that does not require imaging preprocessing to characterize and assess intratumoral immune status, and further investigates its predictive value
for overall survival (OS) in patients with NSCLC undergoing surgical resection.

This retrospective study included two separate NSCLC cohorts (Resec1, n = 149; Resec2, n = 97) to develop and validate iEDI and classify
intratumoral immune status.
Paraffin-embedded excision specimens of Resec1 and Resec2 were immunohistochemically stained and the density percentage of CD3+, CD4+, and CD8+ T cells over all cells was quantified to estimate intratumor-immune status
.
Then, preoperative computed tomography was used to extract EDI features and an imaging biomarker called iEDI was developed to determine immune status
.
In patients with NSCLC undergoing surgical resection (Resec1; Resec2； The internal cohort Resec3, n=419; the external cohort Resec4, n=96; and the TCIA cohort Resec5, n=55) explored the prognostic value
of iEDI.

iEDI successfully classified
the immune status of Resec1 (AUC 0.
771, 95% confidence interval [CI] 0.
759-0.
783; internally validated 0.
770) and Resec2 (0.
669, 0.
647-0.
691).
。 Patients with high iEDI scores had longer
overall survival (OS) in Resec3 (unadjusted hazard ratio 0.
335, 95% CI 0.
206 to 0.
546, p<0.
001), Resec4 (0.
199, 0.
040 to 1.
000, p<0.
001), and TCIA (0.
303, 0.
098 to 0.
944, p=0.
001).

Figure the clinical manifestations
of iEDI, tumor volume, and tumor-related risk parameters.
Cohorts Resec1(A), Resec2(B), Resec3(C), Resec4(D), TCIA(E), and resection (a combination of Resec1 to Resec4 cohorts, F).

This study established and validated a pre-treatment CT-based imaging metric called iEDI
to explain the intratumoral immune status of TIME in NSCLC.
The results of this study show that this novel imaging index is an efficient, non-invasive and reliable clinical prognosis prediction tool, which can assist the clinical selection of personalized treatment options for patients with NSCLC
.

Original source:

Lan He,Zhen-Hui Li,Li-Xu Yan,et al.
Development and validation of a computed tomography-based immune ecosystem diversity index as an imaging biomarker in non-small cell lung cancer.
DOI:10.
1007/s00330-022-08873-6