Alex P. Sanchez-Covarrubias

The Vaginal Microbiome is Associated with Endometrial Cancer Grade and Histology

The human microbiome has been strongly correlated with disease pathology and outcomes, yet remains relatively underexplored in patients with malignant endometrial disease. In this study, vaginal microbiome samples were prospectively collected at the time of hysterectomy from 61 racially and ethnically diverse patients from three disease conditions: (i) benign gynecologic disease (controls, n = 11), (ii) low-grade endometrial carcinoma (n = 30), and (iii) high-grade endometrial carcinoma (n = 20). Extracted DNA underwent shotgun metagenomics sequencing, and microbial α and β diversities were calculated. Hierarchical clustering was used to describe community state types (CST), which were then compared by microbial diversity and grade. Differential abundance was calculated, and machine learning utilized to assess the predictive value of bacterial abundance to distinguish grade and histology. Both α- and β-diversity were associated with patient tumor grade. Four vaginal CST were identified that associated with grade of disease. Different histologies also demonstrated variation in CST within tumor grades. Using supervised clustering algorithms, critical microbiome markers at the species level were used to build models that predicted benign versus carcinoma, high-grade carcinoma versus benign, and high-grade versus low-grade carcinoma with high accuracy. These results confirm that the vaginal microbiome segregates not just benign disease from endometrial cancer, but is predictive of histology and grade. Further characterization of these findings in large, prospective studies is needed to elucidate their potential clinical applications. Significance: The vaginal microbiome reliably segregates not just benign gynecologic condition from endometrial cancer, but also predicts cancer grade and histology. Patterns of microbial abundance and gene expression should be increasingly considered as a factor in the evolution of precision medicine approaches, especially as they relate to cancer screening, disease pathogenesis, and patient-centered outcomes.

Influence of Race, Ethnicity, and Nativity on Distribution and Outcomes Among Women With Choriocarcinoma in Florida

Introduction While race/ethnicity are established factors of risk and outcomes for multiple cancers in women, nativity may more precisely estimate cancer risk and survival. The role of nativity in choriocarcinoma, a form of gestational trophoblastic neoplasia arising from the placenta, is unexplored. Our objective was to examine how race, ethnicity, and nativity influence disease presentation and survival in women with choriocarcinoma in Florida. Methods Using the Florida Cancer Data System (FCDS), we identified women diagnosed with choriocarcinoma from 1981-2020. Clinicodemographic data were extracted, including nativity (US-born/Non-US-born). Statistical analyses included chi-square, Cox proportional hazards models, and Kaplan-Meier method, with significance set at P < 0.05. Results 262 eligible patients were included. Black women more frequently presented with distant disease vs White women (63.8% vs 46.2%, P = 0.05). Non-US-Born women were older at diagnosis than US-born (32.8 vs 26.7 years, P < 0.01) and received fewer surgical and radiation treatments ( P < 0.05). Nativity, ethnicity, and race were not associated with overall survival (OS) (all P > 0.05). Multivariable analyses adjusted for race and birthplace showed increasing age (HR 1.05 [1.02-1.09], P = 0.023) and surgical treatment (HR 0.28 [0.09-0.79], P = 0.016) were associated with OS. Despite favorable OS, survival curves diverged after initial treatment, favoring White over Black patients, and Hispanic over Non-Hispanic patients, though neither were statistically significant ( P > 0.05). Conclusion Race and nativity are associated with variations in choriocarcinoma presentation and treatment course but do not affect survival. Race and ethnicity may predict post-treatment, long-term survival, though whether this reflects choriocarcinoma biology or broader disparities remain unclear.