| Abstrakt: |
Background/Aims Tumor-infiltrating lymphocytes (TILs) have been associated with prognosis in various cancers. However, their prognostic significance in resected gallbladder cancer remains largely unknown. Methods A total of 253 patients who underwent curative resection for gallbladder cancer were included in this study. H&E stained whole slide images of resected gallbladder cancers were analyzed using the Lunit SCOPE IO, an artificial intelligence (AI)-powered spatial TIL analyzer. Based on the density of intratumoral TILs (iTILs) in the cancer epithelium and stromal TILs (sTILs) in the cancer stroma, three immune phenotypes were defined at a 1 mm² grid level: immune-inflamed phenotype (IIP), immune-excluded phenotype (IEP), and immune-desert phenotype (IDP). The impact of these immune phenotypes on survival outcomes was then analyzed. Results The IDP was associated with shorter disease-free survival (DFS) (hazard ratio [HR] 1.019, 95% confidence interval [CI] 1.003–1.036), along with perineural invasion (HR 3.198, 95% CI 1.108–9.228) and stage III/IV (HR 8.531, 95% CI 3.005–24.223). Adjuvant therapy (HR 0.456, 95% CI 0.217–0.955) was associated with longer DFS. Notably, patients with a grid-level IDP proportion exceeding 50% showed significantly shorter DFS (HR 3.514, 95% CI 1.529–8.074) compared to those with less than 50%. IDP was also independently associated with shorter overall survival (OS) (HR 1.020, 95% CI 1.004–1.036), along with age (HR 1.041, 95% CI 1.006–1.077) and stage III/IV (HR 4.900, 95% CI 2.122–11.312). Conclusion The IDP, identified through AI-powered spatial TIL analysis, is predictive of shorter DFS and OS in resected gallbladder cancer patients. [ABSTRACT FROM AUTHOR] |
