Microbiome impacts quality of life in patients with endometrial cancer and benign gynecological conditions

Purpose: Patients with endometrial cancer (EC), a prevalent gynecologic cancer in the United States, and benign gynecological conditions such as fibroids and endometriosis, experience poor quality of life (QOL). Organisms in vaginal and rectal microbiomes have been previously linked to both adverse symptoms and gynecologic disease. Using gastrointestinal, mental, physical, and sexual health symptoms as a proxy for QOL, we explored QOL relationships with vaginal and rectal microbes between patients with EC and benign gynecological conditions. Methods: Patients undergoing hysterectomy for benign or oncological indications at a single center completed QOL surveys preoperatively. The operating surgeon collected vaginal and rectal swabs prior to surgery. Survey and microbiome data were analyzed separately and then correlated utilizing MicrobiomeAnalyst, analysis of compositions of microbiomes with bias correction (ANCOM-BC), and GraphPad Prism 10.2.3. Results: Sexual interest and Vaginal Assessment Scale (VAS) scores were higher in the benign group. Vaginal species richness was higher in the EC group. Vaginal Porphyromonas negatively correlated to sexual interest in all patients, while Dialister B positively correlated to sexual interest in the benign group. Patients with EC and worse vaginal atrophy had increased vaginal L. iners, despite adjustment for menopausal status. In the rectal microbiome, Gastranaerophilales positively correlated to good mental health and Verrucomicrobiales negatively correlated to vulvar symptoms. Conclusion: Identifying microbiome signatures that impact QOL in patients with EC and benign gynecological conditions increases understanding of how microbes may influence patient wellbeing. We offer preliminary findings for foundational knowledge for future opportunities on improvement of QOL through microbiome modulation.