Differences in T-cell counts and neighborhood patterns in human colorectal adenomas and sessile serrated lesions.

Background: T-cell responses influence recurrence and survival in colorectal cancer. T-cell subset distributions vary by molecular phenotype and location, shaping cytotoxic or immune-cold tumor immune microenvironments (TiMEs). However, the T-cell contexture and their spatial proximities within preinvasive lesions are not well characterized. Methods: We analyzed sessile serrated lesions (SSLs), tubulovillous/villous adenomas (TVs), and tubular adenomas (TAs) from three completed studies (N=120). Whole-slide multiplex immunofluorescence was used to quantify eight T-cell subsets (CD4⁺, CD8⁺, Th1, Th17, Treg, Tc1, Tc17, TcTreg). Counts were compared by histology using a generalized linear mixed model with a negative binomial distribution, including an offset for total cell counts and adjusting for age, sex, anatomic location, and lesion size. Nearest-neighbor (NN) analyses assessed proximities of T-cell pairs across lesion types. Results: TAs and SSLs had higher CD4⁺ and CD8⁺ T-cell counts compared with TVs (q<0.05). SSLs had lower Th17 counts than TAs (q<0.05) and compared with TVs leaned toward fewer Tregs (q=0.07). NN analysis showed that TVs, compared with SSLs and TAs, had increased Treg clustering. In contrast, TA versus SSL comparisons revealed predominant CD4⁺ clustering with Th17, Th1, and CD8⁺ subsets. Conclusion: TVs are characterized by lower T-cell infiltration and a greater tendency for regulatory T-cell clustering, consistent with an immune-cold TiME relative to TAs. SSLs and TAs were both more immune-infiltrated than TVs, but SSLs appeared less inflamed and less dominated by regulatory subsets. In contrast, CD4⁺dominant clustering in TAs suggested stronger helper coordination. Preinvasive lesions therefore demonstrate immune and spatial heterogeneity by lesion types.