Spatial transcriptomics of cervical cancer reveals microenvironment shaped the malignant epithelial programs and ECM-associated immune niches

OBJECTIVES: Cervical cancer progression and therapeutic response are influenced by intratumoral heterogeneity and the tumor microenvironment. The diversity of malignant epithelial subtypes and their interactions with immune cells present significant challenges for effective clinical management. METHODS: We applied Stereo-seq spatial transcriptomics to FFPE cervical cancer specimens to define malignant epithelial subpopulations via marker expression, functional enrichment, pseudotime trajectory inference, and transcription factor activity. Findings were validated using immunohistochemistry in CIN III and invasive carcinoma and public scRNA-seq dataset. Cell-cell communication and niche-specific ligand were performed using CellChat and NicheNet. RESULTS: Four malignant epithelial programs were identified, including a proliferative ITGB6⁺ Epi, an invasive-edge ITGA6⁺ Epi enriched for EMT and matrix adhesion, a stress-adaptive NDRG1⁺/PVT1⁺ Epi at the tumor-stroma interface, and a differentiated TMPRSS11D⁺ Epi with barrier-like features. Pseudotime analysis revealed a unidirectional trajectory from ITGB6⁺ progenitor-like cells, diverging toward either ITGA6⁺ or NDRG1⁺ states, converging on TMPRSS11D⁺ differentiation. IHC confirmed stage-associated expression patterns, including ITGB6 upregulated in invasive carcinoma and ITGA6 enriched at invasive fronts. Comparable epithelial heterogeneity was observed in scRNA-seq data. Communication analyses showed broad mesenchymal-epithelial interactions dominated by extracellular matrix ligands, ITGA6⁺ epithelium displaying a distinct matrix-oriented communication signaling profile involving laminin-associated and TGFA-EGFR signaling. NicheNet further highlighted THBS1 as prominent microenvironmental signals predicted to regulate ITGA6-associated targets. CONCLUSIONS: Cervical cancer displays spatially organized epithelial heterogeneity shaped by distinct microenvironmental niches. The ITGA6⁺ epithelial program is closely linked to matrix interactions and THBS1-associated signaling, suggesting a role in invasion and immune modulation.