An algorithm for standardization of tumor Infiltrating lymphocyte evaluation in head and neck cancers

Vasiliki Xirou, Myrto Moutafi, Yalai Bai, Thazin Nwe Aung, Sneha Burela, Matthew Liu, Randall J. Kimple, Fahad Shabbir Ahmed, Bryant Schultz, Douglas Flieder, Denise C. Connolly, Amanda Psyrri, Barbara Burtness, David L. Rimm

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


PURPOSE: The prognostic and predictive significance of pathologist-read tumor infiltrating lymphocytes (TILs) in head and neck cancers have been demonstrated through multiple studies over the years. TILs have not been broadly adopted clinically, perhaps due to substantial inter-observer variability. In this study, we developed a machine-based algorithm for TIL evaluation in head and neck cancers and validated its prognostic value in independent cohorts.

EXPERIMENTAL DESIGN: A network classifier called NN3-17 was trained to identify and calculate tumor cells, lymphocytes, fibroblasts and "other" cells on hematoxylin-eosin stained sections using the QuPath software. These measurements were used to construct three predefined TIL variables. A retrospective collection of 154 head and neck squamous cell cancer cases was used as the discovery set to identify optimal association of TIL variables and survival. Two independent cohorts of 234 cases were used for validation.

RESULTS: We found that electronic TIL variables were associated with favorable prognosis in both the HPV-positive and -negative cases. After adjusting for clinicopathologic factors, Cox regression analysis demonstrated that electronic total TILs% (p = 0.025) in the HPV-positive and electronic stromal TILs% (p < 0.001) in the HPV-negative population were independent markers of disease specific outcomes (disease free survival).

CONCLUSIONS: Neural network TIL variables demonstrated independent prognostic value in validation cohorts of HPV-positive and HPV-negative head and neck cancers. These objective variables can be calculated by an open-source software and could be considered for testing in a prospective setting to assess potential clinical implications.

Original languageEnglish
Article number106750
Pages (from-to)106750
JournalOral Oncology
Early online dateFeb 27 2024
StatePublished - May 2024


  • Biomarker
  • HPV
  • Head and neck cancer
  • Prognosis
  • QuPath
  • TILs
  • Humans
  • Middle Aged
  • Male
  • Algorithms
  • Female
  • Aged
  • Lymphocytes, Tumor-Infiltrating/pathology
  • Retrospective Studies
  • Head and Neck Neoplasms/pathology


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