Value of computed tomography-defined visceral fat area as a risk factor for endometrial cancer

Abstract

Value of computed tomography-defined visceral fat area as a risk factor for endometrial cancer Jae-hyun Cho1 , Jeong Sig Kim1, *, Suyeon Park2 , Woo Young Kim3 1Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, 04401 Seoul, Republic of Korea 2Department of Biostatistics, Soonchunhyang University College of Medicine, 04401 Seoul, Republic of Korea 3Department of Obstetrics & Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Republic of Korea *Correspondence: jskim@schmc.ac.kr (Jeong Sig Kim) DOI:10.31083/j.ceog.2021.02.2297 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 17 September 2020 Revised: 07 December 2020 Accepted: 11 December 2020 Published: 15 April 2021 Objective: Obesity is a risk factor for endometrial cancer. Recently, visceral fat is strongly associated with obesity-related carcinogenesis, more than subcutaneous fat. In this study, we hypothesized that the visceral fat measured by computed tomography (CT) contributes to the occurrence of endometrial cancer. Methods: A retrospective chart review of patients undergoing primary surgery for endometrial cancer was conducted. The volume of visceral fat was measured by CT scans performed at the fourth lumbar level for all participants. Body fat distributions assessed by a direct method in 52 endometrial cancer cases were compared with those of age- and BMImatched healthy community controls. Results: Case group showed significantly higher mean visceral fat area (VFA; 76.2 ± 25.0 vs. 62.2 ± 13.9 cm2 , P = 0.007). The mean total fat area (TFA; 270.3 ± 99.9 vs. 238.9±53.8 cm2 , P = 0.137) and subcutaneous fat area (SFA; 194.2 ± 86.5 vs. 176.7 ± 45.8 cm2 , P = 0.315), however, presents no significant diȞferences. VFA showed lower correlation with BMI (r2 = 0.299, P < 0.001) than to SFA (r2 = 0.528, P < 0.001) or TFA (r2 = 0.584, P < 0.001). In receiver operator characteristic (ROC) curve, at a VFA value of 70.8 cm2 , sensitivity and specificity of the case group was 55.8% and 75%, respectively. Conclusion: Increased abdominal visceral fat is associated with endometrial cancer risk and can be predicted by measuring CT scans. Furthermore, as the most independent factor of BMI, VFA may provide additional information for representative risks of endometrial cancer. Keywords Intra-abdominal fat; Computed tomography; Body fat distribution; Endometrial neoplasms