Intratumoral Abundance of M2-Macrophages is Associated With Unfavorable Prognosis and Markers of T-Cell Exhaustion in Small Cell Lung Cancer Patients

Sebastian Klein; Annalena Schulte; Christoph Arolt; Yuri Tolkach; Hans Christian Reinhardt; Reinhard Buettner; Alexander Quaas

doi:10.1016/j.modpat.2023.100272

Intratumoral Abundance of M2-Macrophages is Associated With Unfavorable Prognosis and Markers of T-Cell Exhaustion in Small Cell Lung Cancer Patients

Mod Pathol. 2023 Oct;36(10):100272. doi: 10.1016/j.modpat.2023.100272. Epub 2023 Jul 7.

Authors

Sebastian Klein¹, Annalena Schulte², Christoph Arolt², Yuri Tolkach², Hans Christian Reinhardt³, Reinhard Buettner², Alexander Quaas²

Affiliations

¹ Institute for Pathology and Neuropathology, University Hospital and Medical Faculty Cologne, and Center for Molecular Medicine, Cologne, Germany; Department of Hematology and Stem Cell Transplantation, University Duisburg-Essen, University Hospital Essen, Essen, Germany; West German Cancer Center Network, Partner Site Essen, Essen, Germany. Electronic address: sebastian.klein@uk-essen.de.
² Institute for Pathology and Neuropathology, University Hospital and Medical Faculty Cologne, and Center for Molecular Medicine, Cologne, Germany.
³ Department of Hematology and Stem Cell Transplantation, University Duisburg-Essen, University Hospital Essen, Essen, Germany; West German Cancer Center Network, Partner Site Essen, Essen, Germany; German Cancer Consortium, Heidelberg, Germany.

PMID: 37423586
DOI: 10.1016/j.modpat.2023.100272

Abstract

Small cell lung cancer (SCLC) accounts for about 10% to 15% of lung cancer cases. Unlike non-SCLC, therapy options for SCLC are limited, reflected by a 5-year survival rate of about 7%. At the same time, the rise of immunotherapeutic approaches in cancer therapy has rationalized to account for inflammatory phenotypes in tumors. However, the composition of the inflammatory microenvironment in human SCLC is poorly understood to date. In our study, we used in-depth image analysis of virtual whole-slide-images of 45 SCLC tumors and evaluated different markers of M2-macrophages (CD163 and CD204) together with global immunologic markers (CD4, CD8, CD68, CD38, FOXP3, and CD20) and characterized their abundance intratumorally using quantitative image analysis, combined with a deep-learning model for tumor segmentation. In addition, independent scoring, blinded to the results of the computational analysis, was performed by an expert pathologist (A.Q.) of both CD163/CD204 and PD-L1. To this end, we evaluated the prognostic relevance of the abundance of these cell types to overall survival. Given a 2-tier threshold of the median of the M2 marker CD163 within the study population, there was a 12-month overall survival rate of 22% (95% CI, 10%-47%) for patients with high CD163 abundance and 41% (95% CI, 25%-68%) for patients with low CD163 counts. Patients with increased CD163 had a median overall survival of 3 months compared to 8.34 months for patients with decreased CD163 counts (P = .039), which could be confirmed by an expert pathologist (A.Q., P = .018). By analyzing cases with increased CD163 cell infiltrates, a trend for higher FOXP3 counts and PD-L1 positive cells, together with increased CD8 T-cell infiltrates, was observed, which could be confirmed using an independent cohort at the transcriptional level. Together, we showed that markers of M2 were associated with unfavorable outcome in our study cohort.

Keywords: CD163; M2; SCLC; TME; biomarker; lung cancer; macrophages; small cell lung cancer; tumor microenvironment.