Visceral fat percentage for prediction of outcome in uterine cervical cancer

Objective. The prognostic role of adiposity in uterine cervical cancer (CC) is largely unknown. Abdominal fat distribution may better reflect obesity than body mass index. This study aims to describe computed tomography (CT)-assessed abdominal fat distribution in relation to clinicopathologic characteristics, survival, and tumor gene expression in CC.Methods. The study included 316 CC patients diagnosed during 2004-2017 who had pre-treatment abdomi-nal CT. CT-based 3D segmentation of total-, subcutaneous-and visceral abdominal fat volumes (TAV, SAV and VAV) allowed for calculation of visceral fat percentage (VAV% = VAV/TAV). Liver density (LD) and waist circum-ference (at L3/L4-level) were also measured. Associations between CT-derived adiposity markers, clinicopatho-logic characteristics and disease-specific survival (DSS) were explored. Gene set enrichment of primary tumors were examined in relation to fat distribution in a subset of 108 CC patients.Results. High TAV, VAV and VAV% and low LD were associated with higher age (& GE;44 yrs.; p & LE; 0.017) and high International Federation of Gynecology and Obstetrics (FIGO) (2018) stage (p & LE; 0.01). High VAV% was the only CT-marker predicting high-grade histology (p = 0.028), large tumor size (p = 0.016) and poor DSS (HR 1.07, p < 0.001). Patients with high VAV% had CC tumors that exhibited increased inflammatory signaling (false dis-covery rate [FDR] < 5%).Conclusions. High VAV% is associated with high-risk clinical features and predicts reduced DSS in CC patients. Furthermore, patients with high VAV% had upregulated inflammatory tumor signaling, suggesting that the met-abolic environment induced by visceral adiposity contributes to tumor progression in CC.& COPY; 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

Automated summary

This study reveals the relationship between abdominal fat distribution and clinicopathologic characteristics, survival, and tumor gene expression in uterine cervical cancer (CC). High visceral fat percentage is associated with high-risk clinical features and reduced survival, and is also linked to upregulated inflammatory tumor signaling.