Abstract
ObjectivesTo investigate the role of functional visceral fat activity assessed by preoperative F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in colorectal cancer (CRC) for predicting regional lymph node (LN) or distant metastasis.MethodWe evaluated 131 patients with newly diagnosed CRC. They all underwent pre-operative 18F-FDG PET/CT and surgery. Functional fat activity was measured by maximum standardized uptake value (SUVmax) using 18F-FDG PET/CT. Functional visceral fat activity was measured by SUVmax of visceral fat/SUVmax of subcutaneous fat (V/S) ratio. Mann-Whitney U test, χ2 test, Fisher’s exact test, receiver-operating characteristic (ROC) analysis, Spearrman’s correlation coefficient, and uni- and multivariate logistic regression statistical analyses were done.ResultsPatients with higher V/S ratio displayed a significantly higher rate of regional LN (p = 0.004) and distant metastasis (p<0.001). In addition, V/S ratio was the only factor that was significantly associated with distant metastasis. An optimal cut-off V/S ratio of 1.88 was proposed for predicting distant metastasis with a sensitivity of 84.6% and specificity of 78.8% (area under the curve: 0.86; p<0.0001)ConclusionFunctional visceral fat activity is significantly associated with distant metastasis in CRC patients. Furthermore, V/S ratio can be useful as a complementary factor in predicting distant metastasis.
Highlights
Colorectal cancer (CRC) is the one of the leading causes of cancer death worldwide [1]
visceral fat/SUVmax of subcutaneous fat (V/S) ratio was the only factor that was significantly associated with distant metastasis
Functional visceral fat activity is significantly associated with distant metastasis in CRC patients
Summary
Colorectal cancer (CRC) is the one of the leading causes of cancer death worldwide [1]. Visceral obesity is closely related with dysregulated visceral adipose tissue activity [8]. This dysregulated visceral adipose tissue secretes increased adipokines including interleukin-6 (IL-6) and tumor necrosis factoralpha (TNF-α) [8,9,10]. These increased adipokines are related with systemic inflammation and can play a role in tumorigenesis and metastasis [8,9,10]. It is conceivable that increased inflammatory condition of visceral adipose tissue activity might affect the status of regional LN or distant metastasis in CRC patients
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