Uterine-cavity Lactobacillus relative abundance and endometrial polyp recurrence after hysteroscopic polypectomy: a retrospective cohort study.
- 1Department of Gynecology, Jinan Maternity and Child Care Hospital, Jinan, Shandong, China.
- 2Department of Obstetrics and Gynecology, Huai'an Clinical Medical College of Jiangsu University (Huai'an Hospital of Huai'an City), Huai'an, Jiangsu, China.
- 3Department of Gynaecology, Shandong Provincial Third Hospital, Jinan, Shandong, China.
Abstract
Background
Endometrial polyps are among the most common benign uterine lesions, yet their recurrence after hysteroscopic polypectomy remains poorly understood. Emerging evidence suggests that uterine-cavity microbial composition may be related to endometrial inflammation and tissue biology. However, the association between uterine microbiome composition and polyp recurrence has not been systematically investigated.Methods
We conducted a single-center retrospective cohort study of 288 women who underwent hysteroscopic polypectomy between January 2021 and June 2024. Uterine cavity fluid was collected intraoperatively for 16S rRNA amplicon sequencing (V3-V4 region). Patients were classified into Lactobacillus-Dominant (LD, n = 156) and Lactobacillus-Non-Dominant (LND, n = 132) groups based on Lactobacillus relative abundance ≥70%. The primary outcome was endometrial polyp recurrence confirmed by hysteroscopy at 12 months. Multivariable Cox proportional hazards regression identified independent predictors of recurrence.Results
The 12-month recurrence rate was higher in the LND group than in the LD group (31.8% vs. 14.1%, p < 0.001). LND samples had higher relative abundances of Gardnerella (15.3%), Prevotella (12.1%), and Streptococcus (8.7%), higher Shannon diversity (3.87 ± 0.98 vs. 1.34 ± 0.52, p < 0.001), and higher serum IL-6 and CRP levels. In the multivariable Cox model, LND status remained associated with recurrence (adjusted HR 2.41; 95% CI 1.48-3.93; p = 0.001). BMI ≥ 28 kg/m², polyp size ≥15 mm, multiplicity, and postoperative hormonal therapy were also associated with recurrence; the hormonal-therapy estimate indicated lower recurrence (adjusted HR 0.48). These estimates are observational and may be affected by residual confounding.Conclusion
Lactobacillus-non-dominant uterine-cavity microbiome status was associated with higher 12-month endometrial polyp recurrence after hysteroscopic polypectomy after adjustment for measured clinical factors. These findings support further evaluation of uterine microbiome profiles as potential risk-stratification markers, but they do not establish causality or justify routine antimicrobial or microbiome-guided treatment.
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BibTeX
@article{zheng2026uterinecavity,
title = {{Uterine-cavity Lactobacillus relative abundance and endometrial polyp recurrence after hysteroscopic polypectomy: a retrospective cohort study.}},
author = {Tingting Zheng and Cenchuan Guo and Zhan Zhou},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1958046},
url = {https://europepmc.org/article/MED/42909001},
note = {CC BY},
}
RIS
TY - JOUR
TI - Uterine-cavity Lactobacillus relative abundance and endometrial polyp recurrence after hysteroscopic polypectomy: a retrospective cohort study.
AU - Tingting Zheng
AU - Cenchuan Guo
AU - Zhan Zhou
PY - 2026
DA - 2026/10/07
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1958046
UR - https://europepmc.org/article/MED/42909001
AB - Background Endometrial polyps are among the most common benign uterine lesions, yet their recurrence after hysteroscopic polypectomy remains poorly understood. Emerging evidence suggests that uterine-cavity microbial composition may be related to endometrial inflammation and tissue biology. However, the association between uterine microbiome composition and polyp recurrence has not been systematically investigated.Methods We conducted a single-center retrospective cohort study of 288 women who underwent hysteroscopic polypectomy between January 2021 and June 2024. Uterine cavity fluid was collected intraoperatively for 16S rRNA amplicon sequencing (V3-V4 region). Patients were classified into Lactobacillus-Dominant (LD, n = 156) and Lactobacillus-Non-Dominant (LND, n = 132) groups based on Lactobacillus relative abundance ≥70%. The primary outcome was endometrial polyp recurrence confirmed by hysteroscopy at 12 months. Multivariable Cox proportional hazards regression identified independent predictors of recurrence.Results The 12-month recurrence rate was higher in the LND group than in the LD group (31.8% vs. 14.1%, p < 0.001). LND samples had higher relative abundances of Gardnerella (15.3%), Prevotella (12.1%), and Streptococcus (8.7%), higher Shannon diversity (3.87 ± 0.98 vs. 1.34 ± 0.52, p < 0.001), and higher serum IL-6 and CRP levels. In the multivariable Cox model, LND status remained associated with recurrence (adjusted HR 2.41; 95% CI 1.48-3.93; p = 0.001). BMI ≥ 28 kg/m², polyp size ≥15 mm, multiplicity, and postoperative hormonal therapy were also associated with recurrence; the hormonal-therapy estimate indicated lower recurrence (adjusted HR 0.48). These estimates are observational and may be affected by residual confounding.Conclusion Lactobacillus-non-dominant uterine-cavity microbiome status was associated with higher 12-month endometrial polyp recurrence after hysteroscopic polypectomy after adjustment for measured clinical factors. These findings support further evaluation of uterine microbiome profiles as potential risk-stratification markers, but they do not establish causality or justify routine antimicrobial or microbiome-guided treatment.
SN - 2296-2565
ER -