Development and validation of deep learning classifiers to detect Epstein-Barr virus and microsatellite instability status in gastric cancer: a retrospective multicentre cohort study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Hannah Sophie Muti - , RWTH Aachen University (Author)
  • Lara Rosaline Heij - , RWTH Aachen University (Author)
  • Gisela Keller - , Technical University of Munich (Author)
  • Meike Kohlruss - , Technical University of Munich (Author)
  • Rupert Langer - , University of Bern, Kepler University Hospital (Author)
  • Bastian Dislich - , University of Bern (Author)
  • Jae Ho Cheong - , Yonsei University (Author)
  • Young Woo Kim - , National Cancer Center Korea (Author)
  • Hyunki Kim - , Yonsei University (Author)
  • Myeong Cherl Kook - , National Cancer Center Korea (Author)
  • David Cunningham - , Royal Marsden NHS Foundation Trust (Author)
  • William H. Allum - , Royal Marsden NHS Foundation Trust (Author)
  • Ruth E. Langley - , University College London (Author)
  • Matthew G. Nankivell - , University College London (Author)
  • Philip Quirke - , University of Leeds (Author)
  • Jeremy D. Hayden - , Leeds Teaching Hospitals NHS Trust (Author)
  • Nicholas P. West - , University of Leeds (Author)
  • Andrew J. Irvine - , University of Leeds (Author)
  • Takaki Yoshikawa - , National Cancer Center Japan (Author)
  • Takashi Oshima - , Kanagawa Cancer Center Research Institute (Author)
  • Ralf Huss - , University Hospital Augsburg (Author)
  • Bianca Grosser - , University Hospital Augsburg (Author)
  • Franco Roviello - , University of Siena (Author)
  • Alessia d'Ignazio - , University of Siena (Author)
  • Alexander Quaas - , University of Cologne (Author)
  • Hakan Alakus - , University of Cologne (Author)
  • Xiuxiang Tan - , RWTH Aachen University (Author)
  • Alexander T. Pearson - , The University of Chicago (Author)
  • Tom Luedde - , University Hospital Duesseldorf (Author)
  • Matthias P. Ebert - , Heidelberg University  (Author)
  • Dirk Jäger - , Heidelberg University  (Author)
  • Christian Trautwein - , RWTH Aachen University (Author)
  • Nadine Therese Gaisa - , RWTH Aachen University (Author)
  • Heike I. Grabsch - , University of Leeds, Maastricht University (Author)
  • Jakob Nikolas Kather - , RWTH Aachen University, University of Leeds, Heidelberg University  (Author)

Abstract

Background: Response to immunotherapy in gastric cancer is associated with microsatellite instability (or mismatch repair deficiency) and Epstein-Barr virus (EBV) positivity. We therefore aimed to develop and validate deep learning-based classifiers to detect microsatellite instability and EBV status from routine histology slides. Methods: In this retrospective, multicentre study, we collected tissue samples from ten cohorts of patients with gastric cancer from seven countries (South Korea, Switzerland, Japan, Italy, Germany, the UK and the USA). We trained a deep learning-based classifier to detect microsatellite instability and EBV positivity from digitised, haematoxylin and eosin stained resection slides without annotating tumour containing regions. The performance of the classifier was assessed by within-cohort cross-validation in all ten cohorts and by external validation, for which we split the cohorts into a five-cohort training dataset and a five-cohort test dataset. We measured the area under the receiver operating curve (AUROC) for detection of microsatellite instability and EBV status. Microsatellite instability and EBV status were determined to be detectable if the lower bound of the 95% CI for the AUROC was above 0·5. Findings: Across the ten cohorts, our analysis included 2823 patients with known microsatellite instability status and 2685 patients with known EBV status. In the within-cohort cross-validation, the deep learning-based classifier could detect microsatellite instability status in nine of ten cohorts, with AUROCs ranging from 0·597 (95% CI 0·522–0·737) to 0·836 (0·795–0·880) and EBV status in five of eight cohorts, with AUROCs ranging from 0·819 (0·752–0·841) to 0·897 (0·513–0·966). Training a classifier on the pooled training dataset and testing it on the five remaining cohorts resulted in high classification performance with AUROCs ranging from 0·723 (95% CI 0·676–0·794) to 0·863 (0·747–0·969) for detection of microsatellite instability and from 0·672 (0·403–0·989) to 0·859 (0·823–0·919) for detection of EBV status. Interpretation: Classifiers became increasingly robust when trained on pooled cohorts. After prospective validation, this deep learning-based tissue classification system could be used as an inexpensive predictive biomarker for immunotherapy in gastric cancer. Funding: German Cancer Aid and German Federal Ministry of Health.

Details

Original languageEnglish
Pages (from-to)e654-e664
JournalThe Lancet Digital Health
Volume3
Issue number10
Publication statusPublished - Oct 2021
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 34417147