Endoscopic surgery affects the gut microbiota and its metabolism in breast cancer patients

Abstract

Background: Despite the advantages of endoscopic surgery in reducing trauma and enhancing recovery for breast cancer patients, its impact on gut microbiota, which is crucial for health and estrogen metabolism, remains unclear. Further investigation is necessary to fully understand this impact and its implications.

Materials and methods: Between June and December 2022, fecal samples were collected from 20 patients who underwent endoscopic surgery. The gut microbiota composition was determined using 16S rRNA sequencing, while the metabolites were analyzed through liquid chromatography-tandem mass spectrometry (LC-MS/MS). Bioinformatics and statistical analyses were employed to identify significant alterations in microbial taxa abundance and to assess intergroup differences. These analyses included t-tests for pairwise comparisons, one-way ANOVA for multiple group comparisons, and chi-square tests for categorical data analysis.

Results: Endoscopic surgery in breast cancer patients subtly changed gut microbiota diversity and composition. Post-surgery, there was a reduction in Lachnospiraceae, Monoglobaceae and Firmicutes to Bacteroides ratios. Shifts in metabolites were also observed, the changed metabolites impacted pathways such as primary bile biosynthesis and Ascorbate and aldarate metabolism, with PE(PGD1/18:1(9Z)) identified as a key differential metabolite that increased post-surgery. Azasetron, tyramine glucuronide, DL-DOPA, phthalide, acetophenazine, aciclovir, creatinine bicarbonate, and 4-oxo-L-proline being associated with distinct bacterial taxa.

Conclusion: Breast cancer patients undergoing endoscopic surgery experience a shift in their gut microbiota and metabolic profiles. Therefore, postoperative management, with a particular focus on the adjustment of the gut microbiota, is crucial for enhancing patient recovery and health outcomes.

Keywords: 16S rRNA; breast cancer; endoscopic surgery; gut microbiota; metabolites.

Figure 1

Analysis of gut microbiota diversity and composition in breast cancer patients after endoscopic surgery. (A) Alpha-diversity analysis. (B) Beta-diversity analysis. (C) Phylum level. (D) Family level.

Figure 2

Analysis of differences in gut microbiota among patients with breast cancer after endoscopic surgery. (A) LEfSe multilevel species difference discriminant analysis. (B) Comparison of family levels among multiple groups. ^*Indicates the difference between groups p < 0.05. ^**Indicates the difference between groups p < 0.01.

Figure 3

Analysis of metabolites in gut microbiota in patients with breast cancer after endoscopic surgery. (A) Enrichment analysis of differential metabolite KEGG functional pathways. (B) KEGG topology analysis. ^*Indicates the difference between groups p < 0.05. ^**Indicates the difference between groups p < 0.01. ^***Indicates the difference between groups p < 0.001.

Figure 4

Differential metabolite analysis. (A) Cluster analysis of differential metabolites. ROC analysis (B) and abundance (C) of differential metabolites in breast cancer patients after endoscopic surgery.

Figure 5

Correlation analysis between differential metabolites and microbiota. The right-hand side of the figure lists the names of the differential metabolites, while the base presents the gut microbiota. Each cell within the matrix represents the correlation between two attributes—metabolites and associated characteristics. The varying colors within the cells denote the magnitude of the correlation coefficients between the attributes. Asterisks indicate the significance of the p-values, with the following designations: ^*p < 0.05, ^**p < 0.01, and ^***p < 0.001.