The Enhanced Role of Eosinophils in Radiomics-Based Diagnosis of Microvascular Invasion and Its Association with the Immune Microenvironment in Hepatocellular Carcinoma

Dong Liu,1,* Jianmin Wu,2,* Han Wang,3 Hui Dong,3 Lei Chen,4 Ningyang Jia1 1Department of Radiology, The Third Affiliated Hospital of Naval Medical University, Shanghai, 200433, People’s Republic of China; 2Shanghai Key Laboratory of Metabolic Remodeling and Health, Institute of Metabolism and Integrative Biology, Fudan University, Shanghai, 200438, People’s Republic of China; 3Department of Pathology, The Third Affiliated Hospital of Naval Medical University, Shanghai, 200433, People’s Republic of China; 4The International Cooperation Laboratory on Signal Transduction, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ningyang Jia; Lei Chen, Email ningyangjia@163.com; chenlei@smmu.edu.cnObjective: To investigate the role of eosinophil counts (EC) in microvascular invasion (MVI) for enhancing the radiomics based diagnostic model. Additionally, its correlation with early recurrence and tumor immune microenvironment was explored.Methods: Propensity score matching was employed to evaluate on 462 cases whether EC was an independent risk factor for MVI. Subgroup analyses examined EC’s effect on MVI across varying hypersplenism degrees. Univariate-multivariate logistic regression identified MVI’s independent factors to develop a diagnostic model. Univariate-multivariate COX regression determined early recurrence factors. Co-detection by indexing (CODEX) constructed the immune score (IS), and Spearman correlation analyzed its association with peripheral immunity.Results: EC was an independent risk factor for MVI (p=0.038, OR=1.304 (95% CI: 1.014– 1.677)), and its effect on MVI disappeared with the severity of hypersplenism. The diagnostic model with EC was significantly improved (AUC=0.787 (95% CI: 0.737– 0.836) vs AUC=0.748(95% CI: 0.694– 0.802, p=0.005)). MVI was an independent risk factor for early recurrence (p< 0.001, HR = 2.254 (95% CI: 1.557– 3.263)). IS was negatively correlated with lymphocyte counts (R=− 0.311, p=0.022), and positively correlated with EC (R=0.301, p=0.027) and RS (R = 0.315, p = 0.018).Conclusion: EC was an independent risk factor for MVI and was related to the tumor immune microenvironment. EC should be included in the diagnosis of MVI to improve diagnostic efficiency.Keywords: hepatocellular carcinoma, eosinophils, radiomics