Obesity is a chief mediator of endometrial cancer (EC) and is responsible for the increasing incidence and mortality of this malignancy. Obesity induced chronic inflammation, creates a pro-neoplastic environment via local and systemic processes. In other obesity-related cancers, white adipose tissue inflammation (WATi) is an independent predictor of shortened cancer-specific survival. A retrospective study in advanced EC revealed that WATi is associated with shorter progression-free survival. The aim of this prospective study was to investigate the presence of WATi in EC and to evaluate the relationship between WATi and clinicopathologic factors in women with EC.
Patients who underwent primary surgical management of EC, regardless of stage or histology, had omental biopsies collected. WATi was detected by the presence of dead/dying adipocytes surrounded by CD68+ macrophages forming a crown-like structure (CLS). Clinicopathologic data were extracted from medical records. For association with WATi, Wilcoxon rank sum test was used for continuous variables, and the Fisher’s exact or χ2 test for categorical variables.
A total of 101 EC patients who underwent primary surgical management between 2015 and 2019 were included. Of these, 46 (46%) had WATi. The presence of WATi was unaffected by race, histology, FIGO stage, smoking or menopausal state. In contrast, dyslipidemia (39% vs 13%, p = 0.002), hypertension (70% vs 35%, p < 0.001) and diabetes mellitus (13% vs 9%, p = 0.015) were significantly more frequent in EC patients with WATi. The median BMI was 35 kg/m2 and 29 kg/m2 in the WATi versus non WATi patients, respectively (p < 0.001). The median CLS based on BMI was 0.19 CLS/cm2 for those with a BMI of < 25kg/m2, 0.34 CLS/cm2 for those with a BMI of 25-29kg/m2, and 1.01 CLS/cm2 for those with a BMI of > 30kg/m2.
WATi was present in nearly 50% of newly diagnosed EC patients regardless of stage. There was an association between the presence and severity of WATi and BMI among patients with EC. Specifically, WATi was associated with hyperglycemia, hypertension, and diabetes mellitus. Further investigation into the impact of WATi on the tumor microenvironment and patient outcomes is ongoing.
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