Immune microenvironment evolution across the serrated neoplasia pathway and its relevance to immunotherapy

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The serrated neoplasia pathway accounts for 15%-30% of sporadic colorectal cancers, characterized by BRAF V600E mutation and distinct histopathologic features.
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Serrated lesions, particularly sessile serrated lesions, are significant precursors to colorectal cancer and often go undetected during screening.
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Changes in the immune microenvironment may begin before invasive transformation, indicating that immune alterations are integral to serrated lesion progression.
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Serrated lesions exhibit biological heterogeneity, leading to divergent immune responses and potential differences in treatment efficacy.
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Understanding the immune microenvironment in serrated lesions can inform biomarker development and therapeutic strategies for colorectal cancer.

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