Abstract
BackgroundObesity is an important cause of multiple cancer types, amongst which endometrial cancer (EC). The relation between obesity and cancer is complicated and involves alterations in insulin metabolism, response to inflammation and alterations in estradiol metabolism. Visceral obesity is assumed to play the most important role in the first two mechanisms, but its role in estradiol metabolism is unclear. Therefore, this retrospective study explores the relationship of body mass index (BMI), visceral fat volume (VAV) and subcutaneous fat volume (SAV) and serum levels of sex steroids and lipids in patients with endometrial cancer.MethodsThirty-nine postmenopausal EC patients with available BMI, blood serum and Computed Tomography (CT) scans were included. Serum was analyzed for estradiol, dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone, cholesterol, triglycerides and high (HDL), low (LDL) and non-high density (NHDL) lipoprotein. VAV and SAV were quantified on abdominal CT scan images. Findings were interpreted using pearson correlation coefficient and linear regression with commonality analysis.ResultsSerum estradiol is moderately correlated with BMI (r = 0.62) and VAV (r = 0.58) and strongly correlated with SAV (r = 0.74) (p < 0.001 for all). SAV contributes more to estradiol levels than VAV (10.3% for SAV, 1.4% for VAV, 35.9% for SAV and VAV, p = 0.01). Other sex steroids and lipids have weak and moderate correlations with VAV or SAV.ConclusionsThis study shows that serum estradiol is correlated with BMI and other fat-distribution measures in postmenopausal endometrial cancer patients. Subcutaneous fat tissue contributes more to the estradiol levels indicating that subcutaneous fat might be relevant in endometrial cancer carcinogenesis.
Highlights
Obesity is an important cause of multiple cancer types, amongst which endometrial cancer (EC)
Statistical analysis Differences in baseline characteristics, fat distribution values and serum levels between Endometrioid endometrial cancer (EEC) and non-endometrioid endometrial cancer (NEEC) were compared using the χ2 test for discrete variables and the Mann Whitney U test for continuous variables
Alterations in insulin metabolism are mainly mediated by visceral fat volume (VAV) [37, 38]. Combining this with our results suggests that both subcutaneous fat volume (SAV) and VAV are relevant for EC carcinogenesis: SAV is primarily responsible for estradiol production and VAV is involved in alterations leading to hyperinsulinemia
Summary
Obesity is an important cause of multiple cancer types, amongst which endometrial cancer (EC). The relation between obesity and cancer is complicated and involves alterations in insulin metabolism, response to inflammation and alterations in estradiol metabolism. Visceral obesity is assumed to play the most important role in the first two mechanisms, but its role in estradiol metabolism is unclear. This retrospective study explores the relationship of body mass index (BMI), visceral fat volume (VAV) and subcutaneous fat volume (SAV) and serum levels of sex steroids and lipids in patients with endometrial cancer. The biological relation between obesity and cancer is complex, and involves alterations in insulin metabolism, inflammatory response and sex steroid metabolism [7, 8]. EEC carcinogenesis is driven by estradiol, while NEEC is assumed to develop independent of estrogens, recent data suggests that estradiol might play a role in NEEC tumorigenesis [11,12,13]
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