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Vasari-based features nomogram to predict the tumor-infiltrating CD8+ T cell levels in glioblastoma
Caiqiang Xue1 and Junlin Zhou1
1Lanzhou University Second Hospital, Lanzhou, China

Synopsis

Keywords: Tumors (Pre-Treatment), Tumor, glioblastoma; magnetic resonance imaging; apparent diffusion coefficient; CD8+ T cells

Motivation: Tumor-infiltrating CD8+ T cells play a key role in glioblastoma development, malignant progression, and recurrence.

Goal(s): The aim of the study was to establish nomograms based on the VASARI features of multiparametric MRI to determine the expression levels of CD8+ T cells in patients with glioblastoma.

Approach: 140 patients with glioblastoma confirmed by surgery and pathology were retrospectively analyzed. Patients were divided into high and low CD8 expression groups. The MRI images of patients with glioblastoma were analyzed using the VASARI scoring system.

Results: The features with the greatest predictive power for CD8 expression levels were, cystic, hemorrhage, and ependymal extension.

Impact: The VASARI feature-based nomogram model can shows promise to predict the level of infiltrative CD8 expression in GB tumors noninvasively for earlier tissue diagnosis and more aggressive treatment.

Abstract

Abstract Background: Tumor-infiltrating CD8+ T cells play a key role in glioblastoma development, malignant progression, and recurrence. The aim of the study was to establish nomograms based on the Visually AcceSAble Rembrandt Images (VASARI) features of multiparametric magnetic resonance imaging (MRI) to determine the expression levels of tumor-infiltrating CD8+ T cells in patients with glioblastoma. Materials and methods: Pathological and imaging data of 140 patients with glioblastoma confirmed by surgery and pathology were retrospectively analyzed. The levels of tumor-infiltrating CD8+ T cells in tumor tissue samples obtained from patients were quantified using immunohistochemical staining. Patients were divided into high and low CD8 expression groups. The MRI images of patients with glioblastoma were analyzed by two radiologists using the VASARI scoring system. Results: A total of 25 MRI-based VASARI imaging features were evaluated by two neuroradiologists. The features with the greatest predictive power for CD8 expression levels were, cystic (OR, 3.063; 95% CI: 1.387, 6.766; P = 0.006), hemorrhage (OR, 2.980; 95% CI: 1.172, 7.575; P = 0.022), and ependymal extension (OR, 0.257; 95% CI: 0.114 0.581; P = 0.001). A logistic regression model based on these three features showed better sample predictive performance (AUC = 0.745; 95% CI: 0.665, 0.825; Sensitivity = 0.527; Specificity = 0.857). Conclusions: The VASARI feature-based nomogram model can shows promise to predict the level of infiltrative CD8 expression in GB tumors noninvasively for earlier tissue diagnosis and more aggressive treatment.

Acknowledgements

Not applicable.

References

[1] Wang X, Ye J, Gao M, Zhang D, Jiang H, Zhang H, et al. Nifuroxazide inhibits the growth of glioblastoma and promotes the infiltration of CD8 T cells to enhance antitumour immunity. Int Immunopharmacol 2023;118:109987. [2] Nabors LB, Portnow J, Ahluwalia M, Baehring J, Brem H, Brem S, et al. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020;18(11):1537-70. [3] Tan AC, Ashley DM, Lopez GY, Malinzak M, Friedman HS, Khasraw M. Management of glioblastoma: State of the art and future directions. CA Cancer J Clin 2020;70(4):299-312. [4] Pellat A, Barat M. Tumor microenvironment: A new application for radiomics. Diagnostic and interventional imaging 2023;104(3):93-4. [5] Ireland L, Santos A, Ahmed MS, Rainer C, Nielsen SR, Quaranta V, et al. Chemoresistance in Pancreatic Cancer Is Driven by Stroma-Derived Insulin-Like Growth Factors. Cancer Res 2016;76(23):6851-63. [6] Ugel S, Cane S, De Sanctis F, Bronte V. Monocytes in the Tumor Microenvironment. Annu Rev Pathol 2021;16:93-122. [7] Chen DS, Mellman I. Elements of cancer immunity and the cancer-immune set point. Nature 2017;541(7637):321-30. [8] Xue C, Zhou Q, Zhang P, Zhang B, Sun Q, Li S, et al. MRI histogram analysis of tumor-infiltrating CD8+ T cell levels in patients with glioblastoma. Neuroimage Clin 2023;37:103353. [9] La Manna MP, Di Liberto D, Lo Pizzo M, Mohammadnezhad L, Shekarkar Azgomi M, Salamone V, et al. The Abundance of Tumor-Infiltrating CD8(+) Tissue Resident Memory T Lymphocytes Correlates with Patient Survival in Glioblastoma. Biomedicines 2022;10(10).

Figures

Figure 1: X-tile plot provides a correlation between tumor-infiltrating CD8+ T cells and survival. A: The color of the plot represents the strength of the association for each partition, ranging from low (dark, black) to high (bright, green). The color green represents a direct association. B: The optimal cutoff value for CD8+ T cells was 1.8. C: Association between CD8+ T cells and survival (p = 0.0005).

A 68-year-old female with a glioblastoma in the right parietal lobe. A-D. MRI cross-sectional images of T1WI, T2WI, and enhanced T1WI show a subcortical circular mass in the right parietal lobe measuring approximately 50.18mm × 79.67mm with unclear borders and uneven signals. The T1WI signal is low, and the T2WI signal is high, while FLAIR exhibits a high signal with peripheral patchy edema. Ependymal extension was seen, and no cystic or hemorrhage were observed. E. DWI lesions showed isointensity in the main body; F. The CD8+ T cell count is 5 (CD8, ×400).

Figure 3 A 49-year-old female with a glioblastoma in the right temporal lobe. A-D. MRI cross-sectional images of T1WI, T2WI, and enhanced T1WI show a subcortical circular mass in the right parietal lobe measuring approximately 54.17mm × 43.73mm with clear borders and inhomogeneously signals. A patchy high-intensity edema band was seen around, and the solid part was obviously enhanced unevenly after enhancement. Cystic and hemorrhage are visible, and no ependymal extension is seen. E. DWI lesions showed isointensity in the main body; F. The CD8+ T cell count is 1 (CD8, ×400).

Figure 4: The nomogram for the prediction of tumor-infiltrating CD8+ T cells in GBM and its predictive performance. The nomogram was constructed combining the cysts, hemorrhage, and Ependymal Extension.

Proc. Intl. Soc. Mag. Reson. Med. 32 (2024)
3853
DOI: https://doi.org/10.58530/2024/3853