Single-cell and spatial transcriptomic profiling reveals distinct tumor microenvironment dynamics in cervical adenocarcinoma and squamous cell carcinoma.

Cervical cancer (CC), a leading cause of cancer-related deaths among women worldwide, is primarily driven by high-risk human papillomavirus (HPV) infections and comprises two major histological subtypes: adenocarcinoma (AC) and squamous cell carcinoma (SCC). Despite advances in prevention and treatment, the molecular and cellular heterogeneity of these subtypes poses significant challenges to achieving optimal clinical outcomes. Here, we integrate single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) to dissect the cellular and spatial heterogeneity of AC and SCC, uncovering distinct tumor microenvironment (TME) dynamics that underlie their divergent clinical behaviors. Our scRNA-seq analysis reveals that AC is enriched in epithelial cells, while SCC exhibits a more immunogenic TME with elevated plasma cells and NK/T cells. Spatial transcriptomics further highlights robust interactions between CD8 + T cells and epithelial subtypes in SCC, contrasting with the stromal-rich, immune-cold phenotype of AC. We identify subtype-specific immune and stromal features, including ICOS+ Tregs, IDO1+ cancer-associated fibroblasts (CAFs), and PLVAP+ endothelial cells, which may drive immune evasion, angiogenesis, and metastasis. These findings provide a comprehensive framework for understanding CC heterogeneity and offer actionable insights for developing subtype-specific therapeutic strategies, such as combining immune checkpoint inhibitors with stromal-targeting agents. This study underscores the potential of spatial multi-omics technologies to advance precision oncology and improve outcomes for cervical cancer patients.