Clinical value of selected markers of angiogenesis, inflammation, insulin resistance and obesity in type 1 endometrial cancer

Abstract Background: It is a well-known fact show that the risk of developing endometrial cancer (type 1 EC) is strongly associated with obesity. In this study, selected markers, such as obesity, insulin resistance, angiogenesis and inflammation markers related to EC type 1 progression and patients’ survival data were analyzed.Methods: To measure levels of adiponectin, C-reactive protein (CRP), vascular endothelial growth factor-A (VEGF-A), angiopoietin-2 (Ang-2), insulin-like growth factor-1 (IGF-1), insulin and C-peptide in 176 preoperative serum samples, the immunoassay technique (EMIT) has been applied.Results: Angiopoietin-2 levels increase with age (P=0.005), FIGO stage (p=0.042), myometrial invasion (P=0.009) and LVSI (P<0.001). The CRP levels increase with age (P=0.01), as well as the advancement of the FIGO stage (P<0.001), higher tumor grade (P=0.012), and myometrial invasion (P<0.001). A positive correlation between serum Ang-2 and CRP levels was demonstrated (r=0.44; p<0.001). Kaplan-Meier survival analysis showed that patients with high CRP levels in serum and Ang-2 presented a worse outcome (P=0.03 and P=0.015, respectively). Cox regression analysis of individual predictors revealed that high serum levels of Ang-2, CRP, advanced clinical FIGO stage (P<0.001, respectively), old age (P=0.013) were all significant overall survival predictors. By means of multivariate analysis, their predictive significance was confirmed.Conclusion: Our study provides evidence that serum levels of Ang-2 and CRP may serve as predictors for assessment of the clinical stage of type 1 EC and are significantly associated with poor prognosis. It is likely that angiogenesis and inflammation associated with obesity have a significant impact on EC type 1 progression and survival rate of patients.