The effect of visceral obesity on clinicopathological features in patients with endometrial cancer: a retrospective analysis of 200 Chinese patients

Abstract

Background: To assess the effect of visceral adiposity on clinical and pathological characteristics in patients with endometrial cancer.

Methods: A retrospective review of medical documentation was performed in surgically treated endometrial cancer patients from January to November 2015 in our institution. The visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured at the level of umbilicus on single-slice computerized tomography. Visceral adiposity (VAT%) was calculated as VAT/(VAT + SAT).

Results: A total of 200 cases were included in the study. Median age at diagnosis was 54 years old. Most patients presented with early-stage tumor (86.0% for I + II) and endometrioid histology (90.5%). Positive lymph node occurred in 11.0% (22/200) of the patients with the median number of retrieved nodes as 25 (range, 4-56). The entire population had a median body mass index (BMI) of 24.7 kg/m(2) and median VAT% of 31.89%. BMI correlated with total adipose tissue (correlation coefficient = 0.667, P < 0.001), but not with VAT% (P = 0.495). Viscerally obese patients tended to be old and post-menopausal (P < 0.001; P = 0.003). Nodal metastasis and extrauterine disease were more commonly reported in patients with high VAT% (6.0% vs. 16.0%, P = 0.024; 9.0% vs. 19.0%, P = 0.042, respectively). Univariate and multivariate logistic regressions were performed to discern the contribution of variable factors on the lymph node metastasis. Grade (HR = 15.41, 95% CI = 1.60-148.76; P = 0.018), lympho-vascular invasion (HR = 449.61, 95% CI = 31.27-6463.93; P < 0.001) and high VAT% (HR = 6.37, 95% CI = 1.42-28.69; P = 0.016) retained statistical significance for predicting lymph node metastasis.

Conclusions: Viscerally obese patients were more likely to be old and have positive lymph node as well as extrauterine disease. Grade, lympho-vascular invasion presence and visceral adiposity were predictors of nodal disease.

Keywords: Body mass index; Clinicopathological features; Endometrial cancer; Lymph node metastasis; Visceral adiposity.

Fig. 1

Schematic of patients included in the present study. On searching the electronic medical record database, 325 endometrial cancer patients were discharged from our department from 1 January to 1 November 2015. A total of 283 patients underwent primary surgery during the study period. Among them, 83 cases were excluded due to the following reasons: no available CT scan (n = 57), incomplete information (n = 9), concurrent primary ovarian cancer (n = 4), uterine carcinosarcoma (n = 2) and lymphadenectomy not performed (n = 11)

Fig. 2

Measurements of visceral (Pink color) and subcutaneous (blue color) adipose tissue on computerized tomography images. a/b represents different body fat distribution: both patients’ body mass index is 24.7 kg/m², while the visceral adipose tissue percentage (VAT%) is 30.3 % (a) and 56.95 % (b), respectively

Fig. 3

Scatter-plots of body mass index versus different fat distribution parameters. Total adipose tissue (a), subcutaneous adipose tissue (b), visceral adipose tissue (c), and visceral adipose tissue percentage (d)