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Advanced CT imaging features reflect distinct tissue immune profiles and exhibit high prognostic impact on NSCLC


15 Dec 2018


Mini Oral session


Giulia Mazzaschi


Annals of Oncology (2018) 29 (suppl_10): x1-x10. 10.1093/annonc/mdy493


G. Mazzaschi1, P. Pagano1, G. Milanese1, D. Madeddu1, A. Falco1, G. Armani1, G. Bocchialini1, D. Marturano1, L. Ampollini1, B. Lorusso1, C. Lagrasta1, N. Sverzellati1, M. Silva1, M. Tiseo2, F. Quaini1, G. Roti1

Author affiliations

  • 1 Medicine And Surgery, University Hospital of Parma, 43126 - Parma/IT
  • 2 Medicine And Surgery, Università degli Studi di Parma - Facoltà di Medicina e Chirurgia, 43125 - Parma/IT



Intersecting genetic, biologic and clinico-pathological features with high-throughput imaging may pave the way to precision oncology. We advanced the hypothesis that the tumor immune microenvironment (TIME) may imprint on CT scan parameters in a qualitative and quantitative (radiomics) fashion, providing a non-invasive approach to identify new prognostic factors in NSCLC patients.


In this study, we enrolled sixty (31 Adenocarcinoma, 29 Squamous Cell Carcinoma) surgically resected patients. We defined TIME by the quantitative assessment of PD-L1 expression and a detailed morphometric evaluation of Tumor Infiltrating Lymphocytes (TILs). Next, from each tumor associated images we extrapolated 841 CT radiomic features through an open-source (3d Slicer) software.


We observed high levels of tissue PD-L1 in radiologic lesions displaying a solid texture and any effect on the surrounding parenchyma (p < 0.05), while well defined CT margins were seen in TILs-rich cases (p < 0.05). The combined analysis of predetermined risk factors from TIME and CT texture had a striking impact on clinical outcome. Patients with low PD-1 expression on CD8+ TILs and CT evidence of tumor effect on parenchyma had significantly increased (p < 0.001) OS with respect to their counterpart (median 50 vs 30 months, HR = 16.82). We also documented prolonged survival (p < 0.05) in cases with well defined CT margins and high CD8-to-CD3 TILs (46 vs 35 months, HR = 2.66). Intriguingly, when an unsupervised hierarchical clustering model was applied to radiomics data, we identified two clusters (A and B) with oppositely regulated features: the first of 57 cases (A), further branching into two continuous different clusters, the second (B) comprised only three patients sharing a mutual genetic (EGFR and KRAS mutations), immunologic (PD-L1, CD3+ and CD8+ TILs, PD-1/CD8 ratio), radiologic (shape, effect, texture and structure) and clinical (relapse and death) profile.


A highly significant prognostic score can be obtained in NSCLC by integrating TIME with CT features. Distinct tissue immune backgrounds may entail imaging textures potentially able to portray a radiologic signature of lung cancer.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

University of Parma.


Has not received any funding.


All authors have declared no conflicts of interest.

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