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11 May 2024 WhARIO: whole-slide-image-based survival analysis for patients treated with immunotherapy
Paul Tourniaire, Marius Ilie, Julien Mazières, Anna Vigier, François Ghiringhelli, Nicolas Piton, Jean-Christophe Sabourin, Frédéric Bibeau, Paul Hofman, Nicholas Ayache, Hervé Delingette
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Journal of Medical Imaging, Vol. 11, Issue 3, 037502 (May 2024). https://doi.org/10.1117/1.JMI.11.3.037502
Abstract

Purpose

Immune checkpoint inhibitors (ICIs) are now one of the standards of care for patients with lung cancer and have greatly improved both progression-free and overall survival, although <20% of the patients respond to the treatment, and some face acute adverse events. Although a few predictive biomarkers have integrated the clinical workflow, they require additional modalities on top of whole-slide images and lack efficiency or robustness. In this work, we propose a biomarker of immunotherapy outcome derived solely from the analysis of histology slides.

Approach

We develop a three-step framework, combining contrastive learning and nonparametric clustering to distinguish tissue patterns within the slides, before exploiting the adjacencies of previously defined regions to derive features and train a proportional hazards model for survival analysis. We test our approach on an in-house dataset of 193 patients from 5 medical centers and compare it with the gold standard tumor proportion score (TPS) biomarker.

Results

On a fivefold cross-validation (CV) of the entire dataset, the whole-slide image-based survival analysis for patients treated with immunotherapy (WhARIO) features are able to separate a low- and a high-risk group of patients with a hazard ratio (HR) of 2.29 (CI95=1.48 to 3.56), whereas the TPS 1% reference threshold only reaches a HR of 1.81 (CI95=1.21 to 2.69). Combining the two yields a higher HR of 2.60 (CI95=1.72 to 3.94). Additional experiments on the same dataset, where one out of five centers is excluded from the CV and used as a test set, confirm these trends.

Conclusions

Our uniquely designed WhARIO features are an efficient predictor of survival for lung cancer patients who received ICI treatment. We achieve similar performance to the current gold standard biomarker, without the need to access other imaging modalities, and show that both can be used together to reach even better results.
© 2024 Society of Photo-Optical Instrumentation Engineers (SPIE)
Citation Download Citation
Paul Tourniaire, Marius Ilie, Julien Mazières, Anna Vigier, François Ghiringhelli, Nicolas Piton, Jean-Christophe Sabourin, Frédéric Bibeau, Paul Hofman, Nicholas Ayache, and Hervé Delingette "WhARIO: whole-slide-image-based survival analysis for patients treated with immunotherapy," Journal of Medical Imaging 11(3), 037502 (11 May 2024). https://doi.org/10.1117/1.JMI.11.3.037502
Received: 18 July 2023; Accepted: 3 April 2024; Published: 11 May 2024
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KEYWORDS
Tissues
Tumors
Education and training
Matrices
Lung cancer
Feature extraction
Lawrencium
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