Computational image features of immune architecture reveal molecular patterns associated with outcome and risk of recurrence in microsatellite-stable or MSI-low colon cancers
In brief
Tumor immune patterns separate colon cancer progression risk by about threefold
In 461 patients with microsatellite-stable or MSI-low colon cancer, a tool measuring immune-cell arrangement on routine slides identified high- and low-risk groups, with about three times the progression hazard in the high-risk group within both stage II and stage III disease. Adding the score improved prediction beyond clinical factors, but prospective validation is still needed.
- Journal
- European journal of cancer (Oxford, England : 1990) (Q1)
- Published
- 29 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Bolin Song, Himanshu Maurya, Sirvan Khalighi, Aya Aqeel, Germán Corredor, Kamal Hammouda, et al.
- PMID
- 42966031
- DOI
- 10.1016/j.ejca.2026.117810
Why clinicians should know about it
- Picked for Histology (top studies of the week, 1 November 2026): Quantifies spatial immune architecture in routine histology images
Abstract
BACKGROUND: Tumor-infiltrating lymphocyte (TIL) density provides prognostic information in colon adenocarcinoma (COAD), but the additional value of TIL spatial organization remains unclear. METHODS: We developed CoATIL, a computational pathology framework quantifying TIL spatial architecture from routine H&E-stained whole-slide images. The study included 461 patients with microsatellite-stable or MSI-low COAD. The model was trained using 140 patients from University Hospitals Cleveland Medical Center, validated internally in 52 patients, and externally in The Cancer Genome Atlas (n = 130), and Guangdong Provincial People's Hospital (n = 139). Prognostic performance was assessed using Kaplan-Meier analysis and multivariable Cox regression. CoATIL was compared with a clinical model and eight foundation-model-based multiple-instance learning approaches. RESULTS: CoATIL was associated with progression-free survival (HR per standard-deviation increase, 1.32; 95% CI 1.13-1.55; p < 0.001; C-index=0.66) and remained prognostic after adjustment for clinicopathologic factors in each validation cohort (adjusted HRs, 2.00-4.40; all p < 0.05). High-versus-low-risk stratification was retained within stage II (HR 3.07; 95% CI 1.83-5.15; p < 0.001) and stage III disease (HR 3.24; 95% CI 1.28-8.19; p = 0.013). The combined clinical-CoATIL model achieved a higher C-index than the clinical model alone (0.69 versus 0.61; paired bootstrap difference, 0.08; 95% CI 0.03-0.14). Exploratory genomic analyses associated AMER1 and FBXW7 mutations with lower and higher CoATIL risk scores, respectively. CONCLUSIONS: Spatial immune architecture extracted from routine histology provides complementary prognostic information in COAD. Prospective validation is warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.