To develop and validate an interpretable deep learning model to predict overall and disease-specific survival (OS/DSS) in clear cell renal cell carcinoma (ccRCC).
Digitised haematoxylin and eosin-stained slides from The Cancer Genome Atlas were used as a training set for a vision transformer (ViT) to extract image features with a self-supervised model called DINO (self-distillation with no labels). Extracted features were used in Cox regression models to prognosticate OS and DSS. Kaplan-Meier for univariable evaluation and Cox regression analyses for multivariable evaluation of the DINO-ViT risk groups were performed for prediction of OS and DSS. For validation, a cohort from a tertiary care centre was used.
A significant risk stratification was achieved in univariable analysis for OS and DSS in the training (n = 443, log rank test, p < 0.01) and validation set (n = 266, p < 0.01). In multivariable analysis, including age, metastatic status, tumour size and grading, the DINO-ViT risk stratification was a significant predictor for OS (hazard ratio [HR] 3.03; 95%-confidence interval [95%-CI] 2.11-4.35; p < 0.01) and DSS (HR 4.90; 95%-CI 2.78-8.64; p < 0.01) in the training set but only for DSS in the validation set (HR 2.31; 95%-CI 1.15-4.65; p = 0.02). DINO-ViT visualisation showed that features were mainly extracted from nuclei, cytoplasm, and peritumoural stroma, demonstrating good interpretability.
The DINO-ViT can identify high-risk patients using histological images of ccRCC. This model might improve individual risk-adapted renal cancer therapy in the future.
World journal of urology. 2023 Jun 29 [Epub ahead of print]
Frederik Wessels, Max Schmitt, Eva Krieghoff-Henning, Malin Nientiedt, Frank Waldbillig, Manuel Neuberger, Maximilian C Kriegmair, Karl-Friedrich Kowalewski, Thomas S Worst, Matthias Steeg, Zoran V Popovic, Timo Gaiser, Christof von Kalle, Jochen S Utikal, Stefan Fröhling, Maurice S Michel, Philipp Nuhn, Titus J Brinker
Digital Biomarkers for Oncology Group, National Centre for Tumour Diseases (NCT), German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany., Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany., Institute of Pathology, Medical Faculty Mannheim of Heidelberg University, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany., Department of Clinical-Translational Sciences, Berlin Institute of Health (BIH), Charité University Medicine, Berlin, Germany., Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany., National Centre for Tumour Diseases, German Cancer Research Centre, Heidelberg, Germany., Digital Biomarkers for Oncology Group, National Centre for Tumour Diseases (NCT), German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .