Tumour infiltrating lymphocytes and survival after adjuvant chemotherapy in patients with gastric cancer: post-hoc analysis of the CLASSIC trial.
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Abstract
Only a subset of gastric cancer (GC) patients with stage II-III benefits from chemotherapy after surgery. Tumour infiltrating lymphocytes per area (TIL density) has been suggested as a potential predictive biomarker of chemotherapy benefit.We quantified TIL density in digital images of haematoxylin-eosin (HE) stained tissue using deep learning in 307 GC patients of the Yonsei Cancer Center (YCC) (193 surgery+adjuvant chemotherapy [Sā+āC], 114 surgery alone [S]) and 629 CLASSIC trial GC patients (325āSā+āC and 304āS). The relationship between TIL density, disease-free survival (DFS) and clinicopathological variables was analysed.YCC S patients and CLASSIC S patients with high TIL density had longer DFS than S patients with low TIL density (Pā=ā0.007 and Pā=ā0.013, respectively). Furthermore, CLASSIC patients with low TIL density had longer DFS if treated with Sā+āC compared to S (Pā=ā0.003). No significant relationship of TIL density with other clinicopathological variables was found.This is the first study to suggest TIL density automatically quantified in routine HE stained tissue sections as a novel, clinically useful biomarker to identify stage II-III GC patients deriving benefit from adjuvant chemotherapy. Validation of our results in a prospective study is warranted.Ā© 2023. The Author(s), under exclusive licence to Springer Nature Limited.