Pan-cancer estimation of prognostic immune biomarkers from histopathology using artificial intelligence

Abstract

Multiplex immunofluorescence (mIF) assays such as ImmunoProfile provide standardized quantification of prognostic immune markers but are costly and not routinely used in clinical settings. We developed a weakly-supervised AI model, HistoProfile, to estimate intratumoral cell densities of key immune biomarkers (CD8, FOXP3, PD-1, and PD-L1) and the PD-L1 tumor proportion score from routine H&E-stained whole-slide images. Trained on a large pan-cancer cohort with paired H&E and mIF data, HistoProfile discriminated biomarker-high from biomarker-low tumors in held-out samples and tumor-specific subgroups (AUROCs of 0.78-0.89 across biomarkers). Critically, the estimated biomarkers preserved prognostic stratification in downstream survival analyses, and showed cancer-specific survival associations across TCGA cohorts where mIF is unavailable. These findings support scalable H&E-based estimation of key immune biomarker measurements for large-scale immune profiling and risk stratification.