Abstract
Obesity contributes to increased cancer incidence and aggressiveness in patients with endometrial cancer. Inflamed metabolic activity of visceral adipose tissue (VAT) is regarded as a key underlying mechanism of adverse consequences of obesity. The aim of this study was to investigate the association between inflammatory metabolic activity of VAT evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and metastatic status of lymph nodes (LN) in patients with endometrial cancer. In total, 161 women with newly diagnosed endometrial cancer, who received preoperative 18F-FDG PET/CT, were enrolled. VAT inflammatory metabolic activity was defined as V/S ratio and measured from the maximum standardized uptake value (SUVmax) of VAT normalized to the SUVmax of subcutaneous adipose tissue (SAT). The positive LN metastasis group exhibited a significantly higher V/S ratio than the negative LN metastasis group. Systemic inflammatory surrogate markers including high sensitivity C-reactive protein, spleen SUVmax, and bone marrow SUVmax were also higher in the LN metastasis group than in the negative LN metastasis group, showing significant correlations with V/S ratio. In multivariate logistic regression analysis, V/S ratio was independently associated with LN metastasis. V/S ratio is independently associated with the LN metastasis status in patients with endometrial cancer. This finding could be useful as a potential surrogate marker of obesity-induced VAT inflammation associated with tumor aggressiveness.
Highlights
Introduction published maps and institutional affilObesity is an important public health issue today
Considering the causal relationship between obesity and endometrial cancer, one crucial pathophysiological mechanism is related to obesity-induced inflammatory metabolic activity of visceral adipose tissue (VAT) that supports tumorigenesis and tumor progression [8,9]
We found that VAT metabolic activity, defined as V/S ratio, was elevated in patients with lymph nodes (LN) metastasis and showed a positive correlation with systemic inflammation surrogate markers
Summary
Obesity is an important public health issue today. It affects more than 600 million people globally. Its prevalence is continuously increasing in both developing and developed countries [3]. Endometrial cancer is the most common gynecologic cancer in developed countries. Its prevalence is continuously increasing worldwide [4]. Accumulating evidences have suggested that obesity elevates cancer risk and tumor aggressiveness, which escalate both morbidity and mortality of endometrial cancer patients [5–7]. Considering the causal relationship between obesity and endometrial cancer, one crucial pathophysiological mechanism is related to obesity-induced inflammatory metabolic activity of visceral adipose tissue (VAT) that supports tumorigenesis and tumor progression [8,9]. Inflamed VAT can secrete an array of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor iations
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