Metabolically active visceral fat linked to aggressive endometrial cancer

High metabolic activity of visceral fat may be associated with more aggressive endometrial cancer, according to a presentation, ‘Visceral Adipose Tissue Metabolism Linked to Aggressiveness in Endometrial Cancer?’, at the 38th Annual Congress of the European Association of Nuclear Medicine.

While obesity is a recognised risk factor for endometrial cancer, the findings indicate that disease aggressiveness may be driven not only by the amount of visceral fat but also by its metabolic activity. Visceral fat is known to influence metabolism and inflammation.

Researchers from Haukeland University Hospital and the University of Bergen analysed PET/CT scans of 274 women with endometrial cancer, measuring glucose uptake in visceral fat as an indicator of metabolic activity. They found that women with higher metabolic activity, assessed by average glucose uptake in visceral fat tissue, were more likely to present with advanced stage disease and lymph node metastases.

"Higher metabolic activity in visceral fat was significantly associated with more advanced cancer stages and the presence of lymph node metastases," explained lead author, Jostein Sæterstøl. "Notably, we saw no strong correlation between the volume of visceral fat and its metabolic activity, suggesting that the link to disease aggressiveness is not merely related to the quantity of fat, but also to its biological activity. The association between higher visceral fat metabolism and aggressive disease is likely driven by multiple mechanisms.”

Measuring visceral fat metabolism with PET/CT is not yet ready for routine clinical use due to technical challenges and variability, especially given the low uptake signal in fat tissue. However, future approaches, including standardized imaging analyses, advanced quantitative PET techniques and artificial intelligence, may help identify high-risk patients, guide treatment decisions and monitor disease progression.

"Chronic inflammation in visceral fat can release cytokines and fatty acids that promote tumor growth and immune evasion. Inflammation is also known to induce insulin resistance, which is another risk factor for cancer progression. In addition, signalling molecules known as adipokines, and crosstalk between fat tissue and tumour cells, may further support cancer spread, particularly to lymph nodes," Sæterstøl added.

Future research will focus on refining measurement methods, improving accuracy through AI-based segmentation and exploring links between visceral fat metabolism and circulating biomarkers such as cytokines and hormones.

The researchers also plan to explore associations with tumor genomic profiles and to assess whether temporal changes in visceral fat activity are associated with disease progression or treatment response.