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High visceral fat to subcutaneous fat ratios portend a poor prognosis in patients with advanced endometrial cancer

  • Elizabeth Buckley
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Mary M. Mullen
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Rehan A. Nizamuddin
    Affiliations
    Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
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  • Jonathan H. Stein
    Affiliations
    Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
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  • Lindsay M. Kuroki
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Katherine C. Fuh
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Andrea R. Hagemann
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Carolyn K. McCourt
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • David Mutch
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Dineo Khabele
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Matthew A. Powell
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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  • Joseph E. Ippolito
    Correspondence
    Correspondence to: J.E. Ippolito, Department of Radiology, 510 S. Kingshighway Blvd, Box 8131, Saint Louis, MO 63110, United States of America.
    Affiliations
    Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America

    Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, United States of America
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  • Premal H. Thaker
    Correspondence
    Correspondence to: P.H. Thaker at, Gynecologic Oncology, Department of Obstetrics & Gynecology, 4911 Barnes Jewish Hospital Plaza, St. Louis, MO 63110, United States of America.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, MO, United States of America
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Published:September 27, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.09.011

      Highlights

      • Advanced stage endometrial cancer can be difficult to treat as there is no definitive optimal treatment regimen.
      • Visceral and subcutaneous fat stores can be easily measured on preoperative CT scans.
      • High visceral to subcutaneous fat ratios were associated with poorer outcomes in this patient cohort.
      • Preoperative CT scans could be used as a screening tool to determine which patients may require more aggressive treatment.

      Abstract

      Objectives

      Visceral adiposity has been established as a predictor of outcomes in various cancers. We aimed to determine the association of radiographic measurements of visceral fat with clinical outcomes in patients with endometrial cancer.

      Methods

      A retrospective review of patients with stage III-IV endometrial cancer who underwent surgery between 2004 and 2014 was performed. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and total adipose tissue (TAT;VAT+SAT) were assessed on preoperative computed tomography (CT) scans. Exploratory analysis was performed to establish the optimal cut-off values for VAT, SAT, and TAT to identify patients with poor prognostic body composition. Survival rates were analyzed using Kaplan-Meier analysis, log-rank tests, and cox-regression.

      Results

      Eighty-three patients were included. Forty-two (51%) patients had a low VAT/SAT ratio (<0.45) and 41 (49.4%) had a high VAT/SAT ratio (>0.45). There were no significant differences in demographics between the groups. The mean VAT, SAT, and TAT were 176.3 cm2, 379.3 cm2, and 555.3 cm2 respectively. Compared to patients with low VAT/SAT ratios, patients with high VAT/SAT ratios had a shorter recurrence-free survival (median 29.6 vs 32.3 months, P = 0.01) and shorter overall survival (median 56 vs 93.7 months, P = 0.03).

      Conclusions

      Visceral fat measurements are predictive of outcomes in patients with advanced stage endometrial cancer. Specifically, VAT to SAT ratios are predictive of overall survival. Future studies should be pursued to identify potential therapeutic targets and biological mechanisms that underlie obesity's relationship with endometrial cancer.

      Keywords

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