Epidemiology, molecular typing, microbiome-immune interactions and treatment strategies of endometrial cancer: a review

Bingyan Liang; Jia Tan; Jia Li; Xiaolan Wang; Genlin Li; Huanhuan Li; Ting Li; Hong Gao

doi:10.3389/fimmu.2025.1595638

Epidemiology, molecular typing, microbiome-immune interactions and treatment strategies of endometrial cancer: a review

Front Immunol. 2025 Jun 25:16:1595638. doi: 10.3389/fimmu.2025.1595638. eCollection 2025.

Authors

Bingyan Liang^{1

2}, Jia Tan³, Jia Li⁴, Xiaolan Wang⁵, Genlin Li⁵, Huanhuan Li⁶, Ting Li⁶, Hong Gao^{2

7

1}

Affiliations

¹ School of Nursing, University of South China, Hengyang, Hunan, China.
² Scientific Research Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
³ Department of Neonatology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
⁴ Operating Room, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
⁵ Center for a Combination of Obstetrics and Gynecology and Reproductive Medicine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
⁶ Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
⁷ Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.

Abstract

This review focuses on the field of endometrial cancer. Since 2020, there have been 417,367 new cases of endometrial cancer diagnosed globally and 97,370 deaths reported. Endometrial cancer ranks second in terms of incidence among female genital malignancies and third in terms of mortality among gynecological cancers. The stage, grade, and histological subtype of endometrial cancer were closely correlated with the risk of recurrence and prognosis for survival. Meanwhile, endometrial cancer exhibits significant biological heterogeneity. The complex interactions among the reproductive tract, host cells, and the microbial environment may harbor novel disease mechanisms. In this review, we provide an overview of the epidemiological characteristics, major risk factors, histological and molecular subtypes of endometrial cancer, as well as explore the associations between the female reproductive tract microbiome, immunity, and cancer progression. We also identify the specific roles of different cytokines in the pathophysiology of endometrial cancer. By integrating findings from diverse research fields, this comprehensive review offers an in-depth understanding of the multidimensional nature of endometrial cancer and highlights the significant potential and promising avenues that microbiological factors present for advancing future cancer research and guiding the development of innovative therapeutic strategies.

Keywords: dysbiosis; endometrial cancer; immune response; inflammation; reproductive tract microbiome.

Publication types

Review

MeSH terms

Endometrial Neoplasms* / epidemiology
Endometrial Neoplasms* / etiology
Endometrial Neoplasms* / immunology
Endometrial Neoplasms* / microbiology
Endometrial Neoplasms* / therapy
Female
Humans
Microbiota* / immunology
Risk Factors