Credit: wildpixel/Getty Images
Researchers in Norway have reported that the levels of metabolic activity found in visceral fat, which surrounds internal organs, can predict the aggressiveness of endometrial cancer. This discovery could enable the use of routine clinical imaging techniques to help physicians identify high-risk patients and make more personalized treatment decisions.
“Higher metabolic activity in visceral fat was significantly associated with more advanced cancer stages and the presence of lymph node metastases,” said lead author Jostein Sæterstøl, medical physicist and PhD candidate at the University of Bergen and the Mohn Medical Imaging and Visualization Centre at Haukeland University Hospital.
Sæterstøl presented these findings on Sunday at the 38th Annual Congress of the European Association of Nuclear Medicine (EANM’25).
Obesity is well established as a risk factor for endometrial cancer, also driving higher mortality rates among these patients. Previous research conducted at the University of Bergen had shown that relying solely on body mass index (BMI) to estimate obesity-related risk factors is insufficient. Instead, they found that a higher percentage of visceral fat is associated with poorer outcomes in endometrial cancer patients.
The current study involved 274 women with endometrial cancer treated at the Haukeland University Hospital. Sæterstøl and colleagues used positron emission tomography-computed tomography (PET-CT) to measure glucose uptake in visceral fat as an indicator of metabolic activity, and found that women with higher levels of metabolic activity in their visceral fat were more likely to be at a more advanced disease stage as well as to show metastasis to the lymph nodes.
“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,” said Sæterstøl.
Compared to subcutaneous fat found in the deeper layers of our skin, which is relatively inert, visceral fat is known to exert a major hormonal influence over metabolism and inflammatory processes across the body. While this type of fat is also associated with a higher risk of cardiovascular disease, type 2 diabetes, and various forms of cancer, knowledge about how visceral fat drives disease is still limited.
“The association between higher visceral fat metabolism and aggressive disease is likely driven by multiple mechanisms,” said Sæterstøl. “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, signaling molecules known as adipokines, and crosstalk between fat tissue and tumor cells, may further support cancer spread, particularly to lymph nodes.”
Understanding the link between visceral fat and patient outcomes could be crucial to improve clinical care by identifying high-risk patients and improving disease monitoring. However, the researchers stated that more work will be needed to overcome technical challenges and adapt the techniques used to measure visceral fat metabolism for routine clinical use.
Future work will focus on refining and standardizing the imaging techniques and introducing artificial intelligence (AI) algorithms to stratify patients. This will allow the research team to continue exploring the links between visceral fat metabolism and blood biomarkers such as cytokines or hormones, as well as study how changes in visceral fat activity affect disease progression and treatment response.