Figure 1. VAT may prime antitumor immunity in women with endometrial cancer and obesity.

Three potential mechanisms explain the paradox underlying the relationship between putative unhealthy VAT and positive clinical responses to immunotherapy in endometrial cancer with abdominal obesity. VAT is a known contributor to a generalized state of chronic sterile metabolic inflammation, in part through systemic release of various inflammatory signals. There may also be a more specific signal emanating from VAT that acts distantly on specific immune cell types in the tumor. Finally, VAT is replete with immune cells and therefore is a theoretical reservoir supporting immune cell trafficking to the tumor site.