Abstract A049: Characterization of the immune tumor microenvironment and its association with cervical cancer health disparities

Abstract Health disparities in cervical cancer outcomes persist, with Black and Hispanic women experiencing more advanced stages at diagnosis and the worst survival rates among self-identified groups. Social determinants of health are the primary drivers of cancer health disparities. Importantly, ancestry and biology contribute as well. In other cancer types, differences in the inflammatory tumor microenvironment (TME) across race and ancestry are reported. However, the inflammatory TME as it relates to cervical cancer health disparities is not well defined. Clinicopathological characteristics were compared between Black (n = 144) and White (n = 198) patients with cervical cancer who received care at Johns Hopkins Medicine between 1995 and 2019. Surgically resected formalin-fixed paraffin-embedded (FFPE) cervical cancer tissues were obtained from Non-Hispanic Black (n = 10), Non-Hispanic White (n = 10), Hispanic Black (n = 5), and Hispanic White (n = 5) women matched on grade, age, and subtype. We performed multiplex immunohistochemical staining of cervical cancer tissue with CD163 (M2 macrophages), tryptase (mast cells), CD66 (granulocyte activation), CD68 (pan-macrophages), and Pan-cytokeratin. Quantitative image analysis was conducted using HALO image analysis software. We then assessed correlations between immune marker expression, FIGO stage, and self-identified race to investigate immunologic characteristics within cervical cancer health disparities. Squamous cell carcinoma was the most frequent histological subtype in both Black (68%) and White (44%) women. Interestingly, Stage II diagnoses were most common among Black women (35%) while Stage IV diagnoses were most common among White women (48%). Yet, progression through treatment was more common among Black women (24%) compared to White women (7%). Using Cox proportional hazards models reveals that self-reported race may be associated with significant differences in survival. In addition, analysis of a cervical cancer public dataset (cBioPortal) revealed different gene mutation profiles across racial groups. How these mutational profiles influence variations in the inflammatory tumor microenvironment warrants further investigation. Preliminary analysis indicates variation in CD163+ macrophage and tryptase+ mast cell densities across patient tissues. Ongoing work will determine associations by tumor subtype, stage, and self-identified race. Profiling cervical cancer in diverse populations may inform novel prognostic, diagnostic, and therapeutic approaches that minimize disparities in gynecologic cancer outcomes. Citation Format: Karissa Becknel, Jelani Jarrett, Luccia S. Yacoub, Mahalia T. Robinson, Terri Mason, Kimberly Levinson, Janielle P. Maynard. Characterization of the immune tumor microenvironment and its association with cervical cancer health disparities abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A049.