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