Endometrium kanseri hastalarında viseral yağ dokusu-kas oranının prognoza etkisi

Abstract

Amaç: Obezite, EK gelişimini obez olmayan hastalara göre 2-5 kat artıran önemli bir risk faktörüdür. Obeziteyi tanımlamakta genellikle vücut kitle indeksi (VKİ) kullanılır. Ancak bu ölçüt; kiloya yağ, kas ve kemiklerin etkisini ayırt etmekte yetersiz kalır. Bu çalışmadaki amaç; viseral ve subkutan yağ dokusu ile birlikte iskelet kasının radyolojik ölçümlerinin, endometrium kanserli hastalarda klinik özellikler ve prognoz ile ilişkisinin incelenmesidir. Yöntem: Retrospektif yapılan bu çalışmaya 2014-2023 yılları arasında primer cerrahisi merkezimizde yapılmış ve endometrial karsinom tanılı, preoperatif BT/MR görüntülerine ve VKİ verilerine erişilen 109 hasta dahil edilmiştir. L3-L4 seviyesinden alınan tek aksiyel kesitte, viseral, subkutan yağ ve iskelet kası alanı ayrı ayrı ölçülmüştür. Bu ölçümler kullanılarak, viseral yağ alanı-kas oranı, toplam yağ alanı-kas oranı ve iskelet kas indeksi hesaplanmıştır. Bulgular: Hastaların tanı anında ortalama yaşı 61,5, ortalama VKİ, 35,24 idi. Dört hastadan üçünün (%74,3) obez (VKİ>30) olduğu görüldü. Yapılan analizlerde ortalama hastalıksız sağkalım 96,1, toplam sağkalım 92,9 ay olarak bulundu. Tanı yaşı ve evre arttıkça rekürrens riskinin ve mortalitenin arttığı görülmüştür. Obezite ilişkili radyolojik ölçümler (SYA, VYA, TYA, İKA) ve bunlar kullanılarak hesaplanan oranların (VYA/İKA, TYA/İKA, SMI) yüksek ve düşük olmak üzere iki gruba bölünmüştür ve klinik özellikler ve sağkalım açısından karşılaştırılmışlardır. İskelet kas alanı yüksek olan hastaların genellikle daha düşük evreli olduğu, iskelet kas alanı düşük olan hastaların yüksek evreli (evre III-IV) olduğu saptanmıştır (p=0,036). Bu gruplar arasında hastalıksız ve toplam sağkalım açısından anlamlı farklılık görülmemiştir. Sonuç: Obezite ve endometrium kanseri ilişkisinin altında yatan hücresel mekanizmaların aydınlatılması, bunların klinik sonuçlarının ve tedavi protokollerine etkisinin anlaşılabilmesi için ileri çalışmalara ihtiyaç vardır.

Keywords

• adipozite
• endometrium kanseri
• obezite
• viseral yağ dokusu
• vücut bileşenleri

The impact of visceral fat-to-muscle ratio on prognosis in patients with endometrial cancer

Abstract

Aim: Obesity increases the risk of endometrial cancer (EC) by 2-5 times compared to non-obese individuals. This study investigates the relationship between radiological measurements of skeletal muscle, visceral, and subcutaneous fat tissue, and their association with clinical features and survival in EC patients. Material and Method: This retrospective study included 109 EC patients who underwent primary surgery between 2014-2024, with preoperative CT/MR imaging and BMI data available. Measurements of visceral fat area (VFA), subcutaneous fat area (SFA), and skeletal muscle area (SMA) were taken at the L3-L4 vertebral level. Ratios of VFA/SMA, total fat area/SMA (TFA/SMA), and skeletal muscle index (SMI) were calculated. Associations between these metrics, clinical features, and survival outcomes were analyzed. Results: The mean age was 61.5 years, with a BMI of 35.24; 74.3% were obese (BMI > 30). Mean disease-free survival was 96.1 months, and overall survival was 92.9 months. Advanced age and higher cancer stage correlated with recurrence and mortality. Higher SMA was associated with lower cancer stages, while lower SMA correlated with stages III-IV (p = 0.036). However, no significant differences in disease-free or overall survival were observed across groups. Conclusions: Skeletal muscle area inversely correlates with cancer stage, indicating a potential protective effect. Obesity-related metrics (VFA, SFA, TFA) showed no significant impact on survival. Further studies are needed to explore underlying mechanisms and clinical relevance.

Keywords

• adiposity
• body composition
• endometrial cancer
• obesity
• visceral fat

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