{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T03:15:15Z","timestamp":1790046915757,"version":"4.0.1"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:sup>18<\/jats:sup>\n                      F-fluorodeoxyglucose positron emission tomography\/computed tomography (\n                      <jats:sup>18<\/jats:sup>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>\n                      This study included patients with newly diagnosed CRC who underwent pre-treatment \u00b9\n                      <jats:sup>8<\/jats:sup>\n                      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\n                      <jats:sub>max<\/jats:sub>\n                      ) of the amygdala to the mean standardized uptake value (SUV\n                      <jats:sub>mean<\/jats:sub>\n                      ) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 \u00b1 0.06 vs. 1.08 \u00b1 0.06;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). 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;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). Univariable analysis identified advanced T stage, lymph node metastasis, elevated AmygA, increased spleen SUV\n                      <jats:sub>max<\/jats:sub>\n                      , and higher serum tumor marker levels as significant variables. In prespecified parsimonious multivariable logistic regression models with bootstrap internal validation, elevated AmygA (&amp;gt; 1.159) remained independently associated with distant metastasis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Elevated amygdala metabolic activity on pre-treatment \u00b9\n                      <jats:sup>8<\/jats:sup>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1747732","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T05:22:45Z","timestamp":1770096165000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Association between chronic stress-related amygdala metabolic activity and distant metastasis in colorectal cancer"],"prefix":"10.3389","volume":"17","author":[{"given":"Hyun Joo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Korea University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sejin","family":"Ha","sequence":"additional","affiliation":[{"name":"Division of 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