In a groundbreaking study published in BMC Cancer, researchers have delved into the intricate relationship between abdominal fat distribution and endometrial cancer, revealing compelling insights that could transform patient diagnosis and long-term management. Utilizing advanced computed tomography (CT) imaging, this extensive investigation sheds new light on how visceral fat, a specific type of abdominal fat, correlates not only with the aggressiveness of endometrial tumors but also with patient prognosis following treatment.
Endometrial cancer, one of the most common gynecological malignancies, poses a significant health burden worldwide. Its association with obesity has been well-documented, yet until now, the precise role that distinct abdominal fat compartments play in the disease’s progression and clinical outcomes has remained elusive. This study pioneers the quantitative exploration of total abdominal fat volume (TAV), subcutaneous abdominal fat volume (SAV), visceral abdominal fat volume (VAV), and the critical ratio of visceral to total fat percentage (VAV%), offering an unprecedented opportunity to understand fat’s nuanced influence on tumor biology.
At the forefront of this research is the use of CT scans acquired at the time of initial diagnosis in a substantial cohort of 293 endometrial cancer patients. This imaging modality allowed for the precise measurement of fat volumes within the abdomen, classifying fat into its two key compartments: subcutaneous, which lies beneath the skin, and visceral, which is found deeper, surrounding internal organs. This distinction is vital, as visceral fat is known to be metabolically active and implicated in chronic inflammation, insulin resistance, and other mechanisms that may promote cancer progression.
One of the pivotal findings revealed that VAV% — the proportion of visceral fat relative to total abdominal fat — significantly correlates with high-risk histologic subtypes of endometrial cancer. Patients exhibiting higher VAV% values were more likely to have aggressive tumor features, including high-grade endometrioid carcinoma and non-endometrioid histologies, which are historically linked to poorer clinical outcomes. This relationship underscores the potential of visceral fat measurement as a biomarker for tumor aggressiveness, assisting clinicians in risk stratification from the outset.
Further analysis unravelled a significant association between elevated VAV% and myometrial invasion, a key factor that describes the extent to which cancer penetrates the muscular layer of the uterus. This invasion depth is critical for staging and prognostication. Additionally, patients with lymphovascular space invasion (LVSI), which reflects the cancer’s ability to disseminate via lymphatic and blood vessels, also demonstrated higher visceral fat percentages. These findings collectively suggest that visceral adiposity might foster a tumor microenvironment conducive to invasive behavior and metastasis.
Beyond diagnostic implications, the study’s longitudinal design offered unique insight into fat dynamics by following 152 patients through serial CT scans a median of 13 months post-diagnosis. Intriguingly, the researchers documented a marked decrease in total, visceral, and subcutaneous fat compartments over this follow-up period. Such changes occurred during or after therapeutic interventions, which often include surgery, chemotherapy, or radiotherapy, known to exert systemic metabolic effects including weight loss.
Crucially, those patients who experienced disease progression during follow-up exhibited a more pronounced reduction in visceral fat compared to their progression-free counterparts. This suggests a complex interaction where not only the quantity of visceral fat but also its temporal loss may serve as an indicator of disease trajectory. The mechanisms could involve cancer cachexia, treatment-related metabolic alterations, or inflammatory responses associated with tumor advancement.
The implications of this visceral fat loss are profound. While obesity is a recognized risk factor for endometrial cancer development, the rapid depletion of visceral fat during ongoing disease may paradoxically herald a worsening clinical course. This dichotomy emphasizes the importance of nuanced fat monitoring, moving beyond simple measurements of body mass index (BMI) to focus on fat distribution and changes therein.
From a clinical perspective, integration of CT-derived fat assessments into routine evaluation presents an opportunity to enhance personalized treatment frameworks. Patients with high visceral fat percentages at diagnosis might benefit from tailored follow-up protocols or adjunctive therapies aimed at mitigating risk. Similarly, monitoring changes in fat compartments longitudinally could provide early warning signs of progression, prompting timely intervention.
On a molecular level, visceral fat’s metabolic activity could influence the tumor microenvironment through the secretion of adipokines, inflammatory cytokines, and growth factors that promote cancer cell survival and proliferation. Furthermore, insulin resistance linked to visceral obesity might exacerbate oncogenic pathways, creating a fertile ground for tumor progression. These mechanistic insights open avenues for translational research aimed at disrupting these pathways to improve patient outcomes.
Moreover, this study calls attention to the need for multidisciplinary approaches, combining oncologic care with metabolic and nutritional management. Strategically addressing visceral adiposity through lifestyle modifications, pharmacologic agents, or metabolic therapies could complement conventional cancer treatments, potentially altering disease course and enhancing survivorship.
The use of quantitative imaging biomarkers delineates a new frontier in oncologic assessment, exemplified by this research. Employing automated or semi-automated CT-based volumetrics enables objective, reproducible fat measurements, facilitating integration into clinical workflows. As imaging technologies evolve, the ability to extract meaningful metabolic and phenotypic data from standard diagnostic scans holds promise for revolutionizing personalized medicine.
Nevertheless, challenges remain. The study’s observational nature precludes definitive conclusions about causality, and further investigations are warranted to elucidate the biological mechanisms linking visceral fat to cancer progression and outcomes. Prospective trials exploring interventions aimed at modifying visceral adiposity in endometrial cancer patients could yield valuable clinical insights.
In addition, expanding the research to diverse populations and other tumor types might reveal broader applicability of visceral fat as a prognostic marker. Given the rising global burden of obesity and associated cancers, understanding fat’s role in oncogenesis and progression is paramount in developing effective strategies for prevention and management.
Taken together, the findings from this meticulous study spotlight visceral abdominal fat as a key player in endometrial cancer biology, bridging gaps between metabolic health and oncologic risk. They advocate for a paradigm shift in cancer diagnostics — one that embraces the complexity of body composition beyond conventional metrics and capitalizes on sophisticated imaging analyses to optimize patient care.
The revelations elucidated here are poised to spark heightened interest and further exploration within the scientific community, potentially guiding future clinical guidelines and research trajectories. As we deepen our grasp on the interplay between fat distribution and cancer behavior, the prospect of more accurate prognostication and targeted therapeutic strategies draws nearer, promising improved patient outcomes in the challenging landscape of endometrial cancer treatment.
Subject of Research:
Quantitative analysis of abdominal fat distribution via CT imaging in endometrial cancer patients, examining its relationship with tumor characteristics and prognosis from diagnosis to follow-up.
Article Title:
Abdominal fat distribution in endometrial cancer: from diagnosis to follow-up.
Article References:
Fasmer, K.E., Sæterstøl, J., Ljunggren, M.B.S. et al. Abdominal fat distribution in endometrial cancer: from diagnosis to follow-up. BMC Cancer 25, 879 (2025). https://doi.org/10.1186/s12885-025-14155-3
Image Credits:
Scienmag.com
DOI:
https://doi.org/10.1186/s12885-025-14155-3
Tags: abdominal fat distributioncomputed tomography imaging in oncologyendometrial cancer researchhealth burden of endometrial cancerimaging techniques in cancer diagnosisobesity and gynecological malignanciespatient management in endometrial cancerquantitative fat volume analysisrelationship between obesity and cancer progressionsubcutaneous vs visceral fat in cancertumor biology and fat compartmentsvisceral fat and cancer prognosis
