Cervical cancer patients' vaginal microbiome and metabolites: research progress and clinical applications

As the fourth most common malignancy among women globally, cervical cancer is intimately linked to persistent high-risk human papillomavirus (HPV) infection; however, HPV infection is not the sole pathogenic factor. Recent studies have revealed that the composition, dynamics, and metabolic products of the vaginal microbiota play pivotal roles in the occurrence, progression, diagnosis, and treatment of cervical cancer. This article offers a comprehensive narrative review of foundational research on the vaginal microbiome in cervical cancer patients, correlations with metabolites, epidemiological characteristics, diagnostic applications, therapeutic strategies, and ongoing controversies and challenges. Basic research demonstrates that increased vaginal microbial diversity and reduced Lactobacillus abundance are associated with cervical cancer progression, wherein pathogenic bacteria such as Fusobacterium spp. and Sneathia spp. have been associated with tumorigenesis through immunosuppression and inflammatory mechanisms. Metabolites like 3-hydroxybutyrate and sphingolipids show potential as diagnostic biomarkers and therapeutic targets. Epidemiological studies reveal associations between variations in the vaginal microbiota across different populations (e.g., African, Latina) and cervical cancer risk. In diagnostics, detection methods based on the vaginal microbiome can enhance early screening efficiency, with novel sequencing technologies combined with artificial intelligence demonstrating promising application prospects. Therapeutically, interventions such as probiotics and microbiota modulation may improve patient outcomes. Nonetheless, current research faces challenges, including an unclear causal relationship between the microbiota and HPV infection and a lack of standardization in detection techniques. Future endeavors necessitate multi-omics integration, large-scale longitudinal studies, and precise intervention strategies to facilitate the clinical translation of vaginal microbiome research into cervical cancer prevention and treatment.