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Debatin NF, Bady E, Mandelkow T, Huang Z, Lurati MCJ, Raedler JB, Müller JH, Vettorazzi E, Plage H, Samtleben H, Klatte T, Hofbauer S, Elezkurtaj S, Furlano K, Weinberger S, Giacomo Bruch P, Horst D, Roßner F, Schallenberg S, Marx AH, Fisch M, Rink M, Slojewski M, Kaczmarek K, Ecke TH, Hallmann S, Koch S, Adamini N, Lennartz M, Minner S, Simon R, Sauter G, Zecha H, Schlomm T, Blessin NC. Prognostic Impact and Spatial Interplay of Immune Cells in Urothelial Cancer. Eur Urol 2024:S0302-2838(24)00065-4. [PMID: 38383257 DOI: 10.1016/j.eururo.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Quantity and the spatial relationship of specific immune cell types can provide prognostic information in bladder cancer. OBJECTIVE To characterize the spatial interplay and prognostic role of different immune cell subpopulations in bladder cancer. DESIGN, SETTING, AND PARTICIPANTS A total of 2463 urothelial bladder carcinomas were immunostained with 21 antibodies using BLEACH&STAIN multiplex fluorescence immunohistochemistry in a tissue microarray format and analyzed using a framework of neuronal networks for an image analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Spatial immune parameters were compared with histopathological parameters and overall survival data. RESULTS AND LIMITATIONS The identification of > 300 different immune cell subpopulations and the characterization of their spatial relationship resulted in numerous spatial interaction patterns. Thirty-nine immune parameters showed prognostic significance in univariate analyses, of which 16 were independent from pT, pN, and histological grade in muscle-invasive bladder cancer. Among all these parameters, the strongest association with prolonged overall survival was identified for intraepithelial CD8+ cytotoxic T cells (time-dependent area under receiver operating characteristic curve [AUC]: 0.70), while stromal CD8+ T cells were less relevant (AUC: 0.65). A favorable prognosis of inflamed cancers with high levels of "exhaustion markers" suggests that TIM3, PD-L1, PD-1, and CTLA-4 on immune cells do not hinder antitumoral immune response in tumors rich of tumor infiltrating immune cells. CONCLUSIONS The density of intraepithelial CD8+ T cells was the strongest prognostic feature in muscle-invasive bladder cancer. Given that tumor cell killing by CD8+ cytotoxic T lymphocytes through direct cell-to-cell-contacts represents the "terminal end route" of antitumor immunity, the quantity of "tumor cell adjacent CD8+ T cells" may constitute a surrogate for the efficiency of cancer recognition by the immune system that can be measured straightaway in routine pathology as the CD8 labeling index. PATIENT SUMMARY Quantification of intraepithelial CD8+ T cells, the strongest prognostic feature identified in muscle-invasive bladder cancer, can easily be assessed by brightfield immunohistochemistry and is therefore "ready to use" for routine pathology.
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Affiliation(s)
- Nicolaus F Debatin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elena Bady
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Mandelkow
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhihao Huang
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Magalie C J Lurati
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas B Raedler
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Jan H Müller
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Plage
- Department of Urology, Charité Berlin, Berlin, Germany
| | - Henrik Samtleben
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Tobias Klatte
- Department of Urology, Charité Berlin, Berlin, Germany; Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | | | | | - Kira Furlano
- Department of Urology, Charité Berlin, Berlin, Germany
| | | | | | - David Horst
- Institute of Pathology, Charité Berlin, Berlin, Germany
| | | | | | - Andreas H Marx
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcin Slojewski
- Department of Urology, University Hospital Stettin, Stettin, Poland
| | | | - Thorsten H Ecke
- Department of Urology, Charité Berlin, Berlin, Germany; Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Steffen Hallmann
- Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Stefan Koch
- Department of Pathology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Nico Adamini
- Department of Urology, Albertinen Hospital, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Zecha
- Department of Urology, Albertinen Hospital, Hamburg, Germany
| | | | - Niclas C Blessin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Müller JH, Plage H, Elezkurtaj S, Mandelkow T, Huang Z, Lurati MCJ, Raedler JB, Debatin NF, Vettorazzi E, Samtleben H, Hofbauer S, Furlano K, Neymeyer J, Goranova I, Ralla B, Weinberger S, Horst D, Roßner F, Schallenberg S, Marx AH, Fisch M, Rink M, Slojewski M, Kaczmarek K, Ecke T, Hallmann S, Koch S, Adamini N, Lennartz M, Minner S, Simon R, Sauter G, Zecha H, Schlomm T, Bady E. Loss of TROP2 and epithelial cell adhesion molecule expression is linked to grade progression in pTa but unrelated to disease outcome in pT2-4 urothelial bladder carcinomas. Front Oncol 2024; 13:1342367. [PMID: 38282671 PMCID: PMC10811247 DOI: 10.3389/fonc.2023.1342367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Trophoblast cell surface antigen 2 (TROP2; EpCAM2) is a transmembrane glycoprotein which is closely related to EpCAM (EpCAM; EpCAM1). Both proteins share partial overlapping functions in epithelial development and EpCAM expression but have not been comparatively analyzed together in bladder carcinomas. TROP2 constitutes the target for the antibody-drug conjugate Sacituzumab govitecan (SG; TrodelvyTM) which has been approved for treatment of metastatic urothelial carcinoma by the United States Food and Drug administration (FDA) irrespective of its TROP2 expression status. Methods To evaluate the potential clinical significance of subtle differences in TROP2 and EpCAM expression in urothelial bladder cancer, both proteins were analyzed by multiplex fluorescence immunohistochemistry in combination with a deep-learning based algorithm for automated cell detection on more than 2,700 urothelial bladder carcinomas in a tissue microarray (TMA) format. Results The staining pattern of TROP2 and EpCAM were highly similar. For both proteins, the staining intensity gradually decreased from pTa G2 low grade (TROP2: 68.8±36.1; EpCAM: 21.5±11.7) to pTa G2 high grade (64.6±38.0; 19.3±12.2) and pTa G3 (52.1±38.7; 16.0±13.0, p<0.001 each). In pT2-4 carcinomas, the average TROP2 and EpCAM staining intensity was intermediate (61.8±40.9; 18.3±12.3). For both proteins, this was significantly lower than in pTa G2 low grade (p<0.001 each) but also higher than in pTa G3 tumors (p=0.022 for TROP2, p=0.071 for EpCAM). Within pT2-4 carcinomas, the TROP2 and EpCAM staining level was unrelated to pT, grade, UICC-category, and overall or tumor-specific patient survival. The ratio TROP2/EpCAM was unrelated to malignant phenotype and patient prognosis. Conclusion Our data show that TROP2 and EpCAM expression is common and highly interrelated in urothelial neoplasms. Despite of a progressive loss of TROP2/EpCAM during tumor cell dedifferentiation in pTa tumors, the lack of associations with clinicopathological parameters in pT2-4 cancer argues against a major cancer driving role of both proteins for the progression of urothelial neoplasms.
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Affiliation(s)
- Jan H. Müller
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Plage
- Department of Urology, Charité Berlin, Berlin, Germany
| | | | - Tim Mandelkow
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhihao Huang
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Magalie C. J. Lurati
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas B. Raedler
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- College of Arts and Sciences, Boston University, Fürth, Germany
| | - Nicolaus F. Debatin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Kira Furlano
- Department of Urology, Charité Berlin, Berlin, Germany
| | - Jörg Neymeyer
- Department of Urology, Charité Berlin, Berlin, Germany
| | | | | | | | - David Horst
- Insitute of Pathology, Charité Berlin, Berlin, Germany
| | | | | | - Andreas H. Marx
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcin Slojewski
- Department of Urology, University Hospital Stettin, Stettin, Poland
| | | | - Thorsten Ecke
- Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Steffen Hallmann
- Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Stefan Koch
- Department of Pathology, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Nico Adamini
- Department of Urology, Albertinen Hospital, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Zecha
- Department of Urology, Albertinen Hospital, Hamburg, Germany
| | | | - Elena Bady
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mandelkow T, Bady E, Lurati MCJ, Raedler JB, Müller JH, Huang Z, Vettorazzi E, Lennartz M, Clauditz TS, Lebok P, Steinhilper L, Woelber L, Sauter G, Berkes E, Bühler S, Paluchowski P, Heilenkötter U, Müller V, Schmalfeldt B, von der Assen A, Jacobsen F, Krech T, Krech RH, Simon R, Bernreuther C, Steurer S, Burandt E, Blessin NC. Automated Prognosis Marker Assessment in Breast Cancers Using BLEACH&STAIN Multiplexed Immunohistochemistry. Biomedicines 2023; 11:3175. [PMID: 38137396 PMCID: PMC10741079 DOI: 10.3390/biomedicines11123175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023] Open
Abstract
Prognostic markers in routine clinical management of breast cancer are often assessed using RNA-based multi-gene panels that depend on fluctuating tumor purity. Multiplex fluorescence immunohistochemistry (mfIHC) holds the potential for an improved risk assessment. To enable automated prognosis marker detection (i.e., progesterone receptor [PR], estrogen receptor [ER], androgen receptor [AR], GATA3, TROP2, HER2, PD-L1, Ki67, TOP2A), a framework for automated breast cancer identification was developed and validated involving thirteen different artificial intelligence analysis steps and an algorithm for cell distance analysis using 11+1-marker-BLEACH&STAIN-mfIHC staining in 1404 invasive breast cancers of no special type (NST). The framework for automated breast cancer detection discriminated normal glands from malignant glands with an accuracy of 98.4%. This approach identified that five (PR, ER, AR, GATA3, PD-L1) of nine biomarkers were associated with prolonged overall survival (p ≤ 0.0095 each) and two of these (PR, AR) were found to be independent risk factors in multivariate analysis (p ≤ 0.0151 each). The combined assessment of PR-ER-AR-GATA3-PD-L1 as a five-marker prognosis score showed strong prognostic relevance (p < 0.0001) and was an independent risk factor in multivariate analysis (p = 0.0034). Automated breast cancer detection in combination with an artificial intelligence-based analysis of mfIHC enables a rapid and reliable analysis of multiple prognostic parameters. The strict limitation of the analysis to malignant cells excludes the impact of fluctuating tumor purity on assay precision.
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Affiliation(s)
- Tim Mandelkow
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Elena Bady
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Magalie C. J. Lurati
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jonas B. Raedler
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- College of Arts and Sciences, Boston University, Boston, MA 02215, USA
| | - Jan H. Müller
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Zhihao Huang
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Till S. Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Institute of Pathology, Clinical Center Osnabrück, 49076 Osnabrück, Germany
| | - Lisa Steinhilper
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Linn Woelber
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Enikö Berkes
- Department of Gynecology, Albertinen Clinic Schnelsen, 22457 Hamburg, Germany
| | - Simon Bühler
- Department of Gynecology, Amalie Sieveking Clinic, 22359 Hamburg, Germany
| | - Peter Paluchowski
- Department of Gynecology, Regio Clinic Pinneberg, 25421 Pinneberg, Germany
| | - Uwe Heilenkötter
- Department of Gynecology, Clinical Centre Itzehoe, 25524 Itzehoe, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | | | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Till Krech
- Institute of Pathology, Clinical Center Osnabrück, 49076 Osnabrück, Germany
| | - Rainer H. Krech
- Institute of Pathology, Clinical Center Osnabrück, 49076 Osnabrück, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Niclas C. Blessin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Bady E, Moeller K, Mandelkow T, Raedler JB, Yang C, Ebner J, Lurati MCJ, Simon R, Vettorazzi E, Buescheck F, Luebke AM, Dum D, Menz A, Sauter G, Hoeflmayer D, Weidemann S, Fraune C, Uhlig R, Bernreuther C, Jacobsen F, Clauditz TS, Wilczak W, Burandt E, Steurer S, Minner S, Lennartz M, Blessin NC. BLEACH&STAIN 15-marker multiplexed imaging in 3098 human carcinomas reveals 6 major PD-L1-driven immune phenotypes with distinct spatial orchestration. Mol Cancer Res 2023:719074. [PMID: 36976297 DOI: 10.1158/1541-7786.mcr-22-0593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/23/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
Multiplex fluorescence immunohistochemistry (mfIHC) approaches were yet either limited to 6 markers or limited to a small tissue size that hampers translational studies on large tissue microarray cohorts. Here we have developed a BLEACH&STAIN mfIHC method that enabled the simultaneous analysis of 15 biomarkers (PD-L1, PD-1, CTLA-4, panCK, CD68, CD163, CD11c, iNOS, CD3, CD8, CD4, FOXP3, CD20, Ki67, CD31) in 3098 tumor samples from 44 different carcinoma entities within one week. To facilitate automated immune checkpoint quantification on tumor and immune cells and study its spatial interplay an artificial intelligence-based framework -incorporating 17 different deep-learning systems- was established. Unsupervised clustering showed that the three PD-L1 phenotypes (PD-L1+tumor and immune cells, PD-L1+immune cells, PD-L1 negative) were either inflamed or non-inflamed. In the inflamed PD-L1+patients, spatial analysis revealed that an elevated intratumoral M2-macrophages as well as CD11c+dendritic cell infiltration (p<0.001 each) was associated with a high CD3+CD4±CD8±FOXP3±T-cell exclusion and a high PD-1 expression on T-cells (p<0.001 each). In breast cancer, the PD-L1 fluorescence intensity on tumor cells showed a significantly higher predictive performance for overall survival (AUC: 0.72, p<0.001) compared to the commonly used percentage of PD-L1+ tumor cells (AUC: 0.54). In conclusion, our deep learning-based BLEACH&STAIN framework facilitates rapid and comprehensive assessment of more than 60 spatially orchestrated immune cell subpopulations and its prognostic relevance. Implications: The development of an easy-to-use high-throughput 15+1 multiplex fluorescence approach facilitates the in-depth understanding of the immune tumor microenvironment and enables to study the prognostic relevance of more than 130 immune cell subpopulations.
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Affiliation(s)
- Elena Bady
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tim Mandelkow
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas B Raedler
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cheng Yang
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Ebner
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ronald Simon
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - David Dum
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Menz
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Ria Uhlig
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Frank Jacobsen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till S Clauditz
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Eike Burandt
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Blessin NC, Yang C, Mandelkow T, Raedler JB, Li W, Bady E, Simon R, Vettorazzi E, Lennartz M, Bernreuther C, Fraune C, Jacobsen F, Krech T, Marx A, Lebok P, Minner S, Burandt E, Clauditz TS, Wilczak W, Sauter G, Heinzer H, Haese A, Schlomm T, Graefen M, Steurer S. Automated Ki-67 labeling index assessment in prostate cancer using artificial intelligence and multiplex fluorescence immunohistochemistry. J Pathol 2023; 260:5-16. [PMID: 36656126 DOI: 10.1002/path.6057] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
The Ki-67 labeling index (Ki-67 LI) is a strong prognostic marker in prostate cancer, although its analysis requires cumbersome manual quantification of Ki-67 immunostaining in 200-500 tumor cells. To enable automated Ki-67 LI assessment in routine clinical practice, a framework for automated Ki-67 LI quantification, which comprises three different artificial intelligence analysis steps and an algorithm for cell-distance analysis of multiplex fluorescence immunohistochemistry (mfIHC) staining, was developed and validated in a cohort of 12,475 prostate cancers. The prognostic impact of the Ki-67 LI was tested on a tissue microarray (TMA) containing one 0.6 mm sample per patient. A 'heterogeneity TMA' containing three to six samples from different tumor areas in each patient was used to model Ki-67 analysis of multiple different biopsies, and 30 prostate biopsies were analyzed to compare a 'classical' bright field-based Ki-67 analysis with the mfIHC-based framework. The Ki-67 LI provided strong and independent prognostic information in 11,845 analyzed prostate cancers (p < 0.001 each), and excellent agreement was found between the framework for automated Ki-67 LI assessment and the manual quantification in prostate biopsies from routine clinical practice (intraclass correlation coefficient: 0.94 [95% confidence interval: 0.87-0.97]). The analysis of the heterogeneity TMA revealed that the Ki-67 LI of the sample with the highest Gleason score (area under the curve [AUC]: 0.68) was as prognostic as the mean Ki-67 LI of all six foci (AUC: 0.71 [p = 0.24]). The combined analysis of the Ki-67 LI and Gleason score obtained on identical tissue spots showed that the Ki-67 LI added significant additional prognostic information in case of classical International Society of Urological Pathology grades (AUC: 0.82 [p = 0.002]) and quantitative Gleason score (AUC: 0.83 [p = 0.018]). The Ki-67 LI is a powerful prognostic parameter in prostate cancer that is now applicable in routine clinical practice. In the case of multiple cancer-positive biopsies, the sole automated analysis of the worst biopsy was sufficient. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Niclas C Blessin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cheng Yang
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Mandelkow
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas B Raedler
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Wenchao Li
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, PR China
| | - Elena Bady
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Marx
- Institute of Pathology, Klinikum Fürth, Fürth, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till S Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Waldemar Wilczak
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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6
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Dum D, Henke TLC, Mandelkow T, Bady E, Raedler JB, Simon R, Sauter G, Lennartz M, Wilczak W, Burandt E, Steurer S, Blessin NC. Abstract P069: Semi-automated validation and quantification of CTLA-4 in 90 different Tumor entities using multiple antibodies and artificial intelligence. Cancer Immunol Res 2022. [DOI: 10.1158/2326-6074.tumimm21-p069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: CTLA-4 is an inhibitory immune checkpoint receptor and a negative regulator of anti-tumor T-cell function. This study aimed at a comparative analysis of CTLA-4+ cells between different tumor entities.
Methods: To quantify CTLA-4+ cells, 4,582 tumor samples from 90 different tumor entities as well as 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry in a tissue microarray format. Two different antibody clones (MSVA-152R and CAL49) were validated and quantified using a deep learning framework for automated exclusion of unspecific immunostaining.
Results: Comparing both CTLA-4 antibodies revealed a clone dependent cytoplasmic cross-reactivity in adrenal cortical adenoma (63%) for MSVA-152R and in pheochromocytoma (67%) as well as hepatocellular carcinoma (36%) for CAL49. After automated exclusion of non-specific staining reaction (3.6%), a strong correlation was observed for the densities of CTLA-4+ lymphocytes obtained by both antibodies (r=0.87; p<0.0001). The mean density of CTLA-4+ cells was 674±1482 cells/mm2 and ranged from 71±175 cells/mm2 in leiomyoma to 5916±3826 cells/mm2 in Hodgkin's lymphoma. Within epithelial tumors, the density of CTLA-4+ lymphocytes were higher in squamous cell (421±467 cells/mm2) and urothelial carcinomas (419±347 cells/mm2) than in adenocarcinomas (269±375 cells/mm2) and renal cell neoplasms (256±269 cells/mm2). A high CTLA-4+ cell density was linked to low pT category (p<0.0001), absent lymph node metastases (p=0.0354), and PD-L1 expression in tumor cells or inflammatory cells (p<0.0001 each). A high CTLA-4/CD3-ratio was linked to absent lymph node metastases (p=0.0295) and to PD-L1 positivity on immune cells (p<0.0026).
Conclusion: Marked differences exist in the number of CTLA-4+ lymphocytes between tumors. Analyzing two independent antibodies by a deep learning framework identifies clone-specific cross-reactivity and facilitates automated quantification of target proteins such as CTLA-4.
Citation Format: David Dum, Tjark L. C. Henke, Tim Mandelkow, Elena Bady, Jonas B. Raedler, Ronald Simon, Guido Sauter, Maximilian Lennartz, Waldemar Wilczak, Eike Burandt, Stefan Steurer, Niclas C. Blessin. Semi-automated validation and quantification of CTLA-4 in 90 different Tumor entities using multiple antibodies and artificial intelligence [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2021 Oct 5-6. Philadelphia (PA): AACR; Cancer Immunol Res 2022;10(1 Suppl):Abstract nr P069.
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Affiliation(s)
- David Dum
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Tjark L. C. Henke
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Tim Mandelkow
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Elena Bady
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Jonas B. Raedler
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
- 2College of Arts and Sciences, Boston University, Boston, MA
| | - Ronald Simon
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Guido Sauter
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Maximilian Lennartz
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Waldemar Wilczak
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Eike Burandt
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Stefan Steurer
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Niclas C. Blessin
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
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7
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Dum D, Henke TLC, Mandelkow T, Yang C, Bady E, Raedler JB, Simon R, Sauter G, Lennartz M, Büscheck F, Luebke AM, Menz A, Hinsch A, Höflmayer D, Weidemann S, Fraune C, Möller K, Lebok P, Uhlig R, Bernreuther C, Jacobsen F, Clauditz TS, Wilczak W, Minner S, Burandt E, Steurer S, Blessin NC. Semi-automated validation and quantification of CTLA-4 in 90 different tumor entities using multiple antibodies and artificial intelligence. J Transl Med 2022; 102:650-657. [PMID: 35091676 PMCID: PMC9162915 DOI: 10.1038/s41374-022-00728-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
CTLA-4 is an inhibitory immune checkpoint receptor and a negative regulator of anti-tumor T-cell function. This study is aimed for a comparative analysis of CTLA-4+ cells between different tumor entities. To quantify CTLA-4+ cells, 4582 tumor samples from 90 different tumor entities as well as 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry in a tissue microarray format. Two different antibody clones (MSVA-152R and CAL49) were validated and quantified using a deep learning framework for automated exclusion of unspecific immunostaining. Comparing both CTLA-4 antibodies revealed a clone dependent unspecific staining pattern in adrenal cortical adenoma (63%) for MSVA-152R and in pheochromocytoma (67%) as well as hepatocellular carcinoma (36%) for CAL49. After automated exclusion of non-specific staining reaction (3.6%), a strong correlation was observed for the densities of CTLA-4+ lymphocytes obtained by both antibodies (r = 0.87; p < 0.0001). A high CTLA-4+ cell density was linked to low pT category (p < 0.0001), absent lymph node metastases (p = 0.0354), and PD-L1 expression in tumor cells or inflammatory cells (p < 0.0001 each). A high CTLA-4/CD3-ratio was linked to absent lymph node metastases (p = 0.0295) and to PD-L1 positivity on immune cells (p = 0.0026). Marked differences exist in the number of CTLA-4+ lymphocytes between tumors. Analyzing two independent antibodies by a deep learning framework can facilitate automated quantification of immunohistochemically analyzed target proteins such as CTLA-4.
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Affiliation(s)
- David Dum
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tjark L. C. Henke
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Mandelkow
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cheng Yang
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elena Bady
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas B. Raedler
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,grid.189504.10000 0004 1936 7558College of Arts and Sciences, Boston University, Boston, MA USA
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Guido Sauter
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Lennartz
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Büscheck
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas M. Luebke
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Menz
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Hinsch
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Doris Höflmayer
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sören Weidemann
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Fraune
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Möller
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Lebok
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ria Uhlig
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Bernreuther
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Jacobsen
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till S. Clauditz
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Waldemar Wilczak
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Burandt
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niclas C. Blessin
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Blessin NC, Bady E, Mandelkow T, Yang C, Raedler JB, Simon R, Fraune C, Lennartz M, Minner S, Burandt E, Höflmayer D, Sauter G, Möller K, Weidemann SA. Abstract P068: Automated cell type specific PD-L1 quantification by artificial intelligence using high throughput bleach & stain 15-marker multiplex fluorescence immunohistochemistry in human cancers. Cancer Immunol Res 2022. [DOI: 10.1158/2326-6074.tumimm21-p068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The quantification of PD-L1 (programmed cell death ligand 1) has been used to predict patient's survival, to characterize the tumor immune microenvironment, and to predict response to immune checkpoint therapies. However, a framework to assess the PD-L1 status with a high interobserver reproducibility on tumor cells and different types of immune cells has yet to be established.
Methods: To study the impact of PD-L1 expression on the tumor immune microenvironment and patient outcome, a framework for fully automated PD-L1 quantification on tumor cells and immune cells was established and validated. Automated PD-L1 quantification was facilitated by incorporating three different deep learning steps for the analysis of more than 80 different neoplasms from more than 10'000 tumor specimens using a bleach & stain 15-marker multiplex fluorescence immunohistochemistry panel (i.e., PD-L1, PD-1, CTLA-4, panCK, CD68, CD163, CD11c, iNOS, CD3, CD8, CD4, FOXP3, CD20, Ki67, CD31). Clinicopathological parameter were available for more than 30 tumor entities and overall survival data were available for 1517 breast cancer specimens.
Results: Comparing the automated deep-learning based PD-L1 quantification with conventional brightfield PD-L1 data revealed a high concordance in tumor cells (p<0.0001) as well as immune cells (p<0.0001) and an accuracy of the automated PD-L1 quantification ranging from 90% to 95.2%. Across all tumor entities, the PD-L1 expression level was significantly higher in distinct macrophage/dendritic cell (DC) subsets (identified by CD68, CD163, CD11c, iNOS; p<000.1) and in macrophages/DCs located in the Stroma (p<0.0001) as compared to intratumoral macrophages/DC subsets. Across all different tumor entities, the PD-L1 expression was highly variable and distinct PD-L1 driven immune phenotypes were identified based on the PD-L1 intensity on both tumor and immune cells, the distance between non-exhausted T-cell subsets (i.e. PD-1 and CTLA-4 expression on CD3+CD8+ cytotoxic T-cells, CD3+CD4+ T-helper cells, CD3+CD4+FOXP3+ regulatory T-cells) and tumor cells as well as macrophage/(DC) subtypes. In breast cancer, the PD-L1 fluorescence intensity on tumor cells showed a significantly higher predictive performance for overall survival with an area under receiver operating curves (AUC) of 0.72 (p<0.0001) than the percentage of PD-L1+ tumor cells (AUC: 0.54). In PD-L1 positive as well as negative breast cancers a close spatial relationship between T- cell subsets (CD3+CD4±CD8±FOXP3±PD-1±CTLA-4±) and Macrophage/DC subsets (CD68±CD163±CD11c±iNOS) was found prognostic relevant (p<0.0001).
Conclusion: In conclusion, multiplex immunofluorescence PD-L1 assessment provides cutoff-free/continuous PD-L1 data which are superior to the conventional percentage of PD-L1+ tumor cells and of high prognostic relevance. The combined analysis of spatial PD-L1/PD-1 data and more than 20 different immune cell subtypes of the immune tumor microenvironment revealed distinct PD-L1 immune phenotypes.
Citation Format: Niclas C. Blessin, Elena Bady, Tim Mandelkow, Cheng Yang, Jonas B. Raedler, Ronald Simon, Christoph Fraune, Maximilian Lennartz, Sarah Minner, Eike Burandt, Doris Höflmayer, Guido Sauter, Katharina Möller, Sören A. Weidemann. Automated cell type specific PD-L1 quantification by artificial intelligence using high throughput bleach & stain 15-marker multiplex fluorescence immunohistochemistry in human cancers [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2021 Oct 5-6. Philadelphia (PA): AACR; Cancer Immunol Res 2022;10(1 Suppl):Abstract nr P068.
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Affiliation(s)
- Niclas C. Blessin
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Elena Bady
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Tim Mandelkow
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Cheng Yang
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Jonas B. Raedler
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
- 2College of Arts and Sciences, Boston University, Boston, MA
| | - Ronald Simon
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Christoph Fraune
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Maximilian Lennartz
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Sarah Minner
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Eike Burandt
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Doris Höflmayer
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Guido Sauter
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Katharina Möller
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - Sören A. Weidemann
- 1Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
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9
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Blessin NC, Li W, Mandelkow T, Jansen HL, Yang C, Raedler JB, Simon R, Büscheck F, Dum D, Luebke AM, Hinsch A, Möller K, Menz A, Bernreuther C, Lebok P, Clauditz T, Sauter G, Marx A, Uhlig R, Wilczak W, Minner S, Krech T, Fraune C, Höflmayer D, Burandt E, Steurer S. Prognostic role of proliferating CD8 + cytotoxic Tcells in human cancers. Cell Oncol (Dordr) 2021; 44:793-803. [PMID: 33864611 PMCID: PMC8338812 DOI: 10.1007/s13402-021-00601-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Expansion of CD8+ cytotoxic Tlymphocytes is a prerequisite for anti-cancer immune activity and has gained interest in the era of immune checkpoint therapy. METHODS To understand the CD8+ T cell dynamics in the tumor microenvironment, we used multiplex fluorescence immunohistochemistry to quantitate CD8+ proliferation (Ki67 co-expression) in tissue microarrays from 1107 colorectal, 642 renal cell, 1066 breast, 375 ovarian, 451 pancreatic and 347 gastric cancer samples. RESULTS The density and the percentage of proliferating (Ki67+) CD8+ T cells were both highly variable between tumor types as well as between patients with the same tumor type. Elevated density and percentage of proliferating CD8+ cytotoxic T cells were significantly associated with favorable tumor parameters such as low tumor stage, negative nodal stage (p ≤ 0.0041 each), prolonged overall survival (p ≤ 0.0028 each) and an inflamed immune phenotype (p = 0.0025) in colorectal cancer and, in contrast, linked to high tumor stage, advanced ISUP/Fuhrman/Thoenes grading (each p ≤ 0.003), shorter overall survival (p ≤ 0.0330 each) and an immune inflamed phenotype (p = 0.0094) in renal cell cancer. In breast, ovarian, pancreatic and gastric cancer the role of (Ki67+)CD8+ Tcells was not linked to clinicopathological data. CONCLUSION Our data demonstrate a tumor type dependent prognostic impact of proliferating (Ki67+)CD8+ Tcells and an inverse impact in colorectal and renal cell cancer.
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Affiliation(s)
- Niclas C Blessin
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Wenchao Li
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Tim Mandelkow
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Hannah L Jansen
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Cheng Yang
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Jonas B Raedler
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.,College of Arts and Sciences, Boston University, Boston, MA, USA
| | - Ronald Simon
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Franziska Büscheck
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - David Dum
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Andreas M Luebke
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Andrea Hinsch
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Katharina Möller
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Anne Menz
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Till Clauditz
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Andreas Marx
- Institute of Pathology, Medical Centre Fürth, D-90766, Fürth, Germany
| | - Ria Uhlig
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Waldemar Wilczak
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Till Krech
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Doris Höflmayer
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
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