Biomarkers of intrinsic angiogenic and anti-angiogenic activity in patients with endometrial hyperplasia and endometrial cancer

Serum vascular endothelial growth factor (VEGF) and endostatin were determi ned in postmenopausal women, including 72 with endometrial cancer, 27 with endometrial hyperplasia and 30 healthy controls. Serum VEGF levels in endom etrial hyperplasia (142 +/- 18 ng/ml, mean +/- SE) and endometrial cancer s tages I (291 +/- 22), II (623 +/- 68) and stage III-IV (1527 +/- 119) were significantly higher than the mean for controls (12 +/- 1.6). Serum endosta tin levels in endometrial hyperplasia (149 +/- 19 ng/ml), endometrial cance r stages I (320 +/- 1), II (644 +/- 86) and stage III-IV (1253 +/- 114) wer e also significantly higher than the mean for controls (13 +/- 2.4). Elevat ed values of VEGF above the non-malignant level were encountered in 7% (sta ge 1), 37% (stage IT) and 100% (stage III-IV) of endometrial cancers. The c orresponding figures for endostatin were 37%, 59% and 100%, respectively. T hese results demonstrate that the circulating levels of both markers correl ated with tumor stage and apparently tumor burden. Serum VEGF and endostati n levels decreased significantly after treatment, followed by marked elevat ions at clinical relapse. The VEGF endostatin ratio was higher in the advan ced stages (> 1.0) than in the early stages of endometrial carcinoma ( < 1. 0), indicating that the balance of angiogenic stimulators and inhibitors ma y regulate metastasis and access tumor progression.