Work

Association between chronic stress-related amygdala metabolic activity and distant metastasis in colorectal cancer

Year: 2026

Type: article

Abstract: Background Chronic stress has been implicated in cancer progression through neuroendocrine and inflammatory pathways, but its role in colorectal cancer (CRC) remains uncertain. The amygdala, a key stress-responsive brain structure, demonstrates measurable metabolic activity on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) and may serve as a surrogate imaging biomarker of chronic stress. This study aimed to investigate whether elevated amygdala metabolic activity (AmygA) is associated with distant metastasis in patients with CRC. Patients and methods This study included patients with newly diagnosed CRC who underwent pre-treatment ¹ 8 F-FDG PET/CT and curative-intent surgery between January 2019 and December 2023. AmygA was defined as the ratio of maximum standardized uptake value (SUV max ) of the amygdala to the mean standardized uptake value (SUV mean ) of the ipsilateral temporal lobe. Receiver-operating characteristic curve analysis determined the optimal AmygA threshold for predicting distant metastasis, and multivariable logistic regression identified independent predictors. Results Seventy-six patients were analyzed, of whom 21 (27.6%) had distant metastasis. AmygA was significantly higher in patients with distant metastasis than in those without (1.17 ± 0.06 vs. 1.08 ± 0.06; p < 0.001). The optimal AmygA cutoff value for predicting distant metastasis was 1.159, yielding 71.4% sensitivity and 89.1% specificity (area under the curve = 0.844; p < 0.001). Univariable analysis identified advanced T stage, lymph node metastasis, elevated AmygA, increased spleen SUV max , and higher serum tumor marker levels as significant variables. In prespecified parsimonious multivariable logistic regression models with bootstrap internal validation, elevated AmygA (> 1.159) remained independently associated with distant metastasis. Conclusions Elevated amygdala metabolic activity on pre-treatment ¹ 8 F-FDG PET/CT, a surrogate marker of chronic stress, was independently associated with distant metastasis in CRC. AmygA might serve as a novel imaging biomarker for risk stratification and offer insight into stress-related neural mechanisms underlying metastatic progression.

Source: Frontiers in Endocrinology

DOI: 10.3389/fendo.2026.1747732

Authors: Hyun Joo Kim, Sejin Ha, Chanmin Joung, Sungeun Kim, Kisoo Pahk

Institutions: Korea University, The Catholic University of Korea Uijeongbu St. Mary's Hospital, Catholic University of Korea, The University of Texas Southwestern Medical Center

Language: English

Topic: Cancer, Stress, Anesthesia, and Immune Response

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801