Abstract
Obesity is known to increase breast cancer risk and aggressiveness in postmenopausal luminal breast cancer and obesity-driven dysfunctional metabolic activity in visceral adipose tissue (VAT) is considered as one of the principal underlying mechanism. We aimed to investigate the relationship between VAT metabolic activity evaluated by preoperative 18F-FDG PET/CT and axillary lymph node (ALN) metastasis in postmenopausal luminal breast cancer patients. In total, 173 patients were enrolled in study. They all underwent preoperative 18F-FDG PET/CT and surgery. VAT metabolic activity was defined as the maximum standardized uptake value (SUVmax) of VAT divided by the SUVmax of subcutaneous adipose tissue (V/S ratio). In luminal breast cancer, the patients with ALN metastasis showed significantly higher V/S ratio than the patients without ALN metastasis. Furthermore, V/S ratio was significantly associated with ALN metastasis in luminal breast cancer patients. Erythrocyte sedimentation rate, which reflect the systemic inflammation, was significantly higher in ALN metastasis group than the negative ALN metastasis group in luminal breast cancer patients and showed significant positive correlation with V/S ratio. V/S ratio significantly affects the ALN metastasis status in postmenopausal luminal breast cancer patients and it may be useful as a potential biomarker of obesity-driven systemic inflammation associated with tumor aggressiveness.
Highlights
Obesity is a major public health problem today that affecting over 600 million adults worldwide and more than 36% of adults in the United States[1,2]
To the best of our knowledge, this is the first study reporting the association between visceral adipose tissue (VAT) metabolic activity and tumor aggressiveness in postmenopausal luminal breast cancer patients using 18F-FDG PET/CT
We clearly identified that the VAT metabolic activity assessed by preoperative 18F-FDG PET/CT was significantly associated in patients with Axillary lymph node (ALN) metastasis compared to patients with negative ALN metastasis, and was correlated with systemic inflammation in postmenopausal luminal breast cancer
Summary
Obesity is a major public health problem today that affecting over 600 million adults worldwide and more than 36% of adults in the United States[1,2]. Dysfunctional VAT secretes pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), thereby stimulating aromatase activity, which eventually drives higher estrogen production to support luminal type breast cancer growth[5,6]. Recently, increased VAT metabolic activity assessed by 18F-FDG PET/CT has been associated with regional lymph node metastasis in thyroid cancer and distant metastasis in colorectal cancer, for which obesity is a risk factor[14,15]. We hypothesized that increased VAT metabolic activity might affect the ALN metastasis in postmenopausal luminal breast cancer patients. The aim of this study was to investigate the relationship between VAT metabolic activity assessed by 18F-FDG PET/CT and the status of ALN metastasis in postmenopausal luminal breast cancer patients
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