The diagnostic value of serum glucagon-like peptide-1 (GLP-1) levels in endometrial cancer among obese women

Abstract

Objective

To evaluate the diagnostic value of serum glucagon-like peptide-1 (GLP-1) levels in obese women with different endometrial pathologies and its independent association with endometrial cancer.

Methods

This prospective cross-sectional study included 180 obese, non-diabetic women undergoing endometrial biopsy for abnormal uterine bleeding, categorized as endometrial polyp (n = 60), endometrial hyperplasia (n = 60), or endometrioid-type endometrial cancer (n = 60). Fasting serum GLP-1 levels were measured by enzyme-linked immunosorbent assay. Correlation, multivariable logistic regression, and receiver operating characteristic (ROC) analyses were performed.

Results

Serum GLP-1 levels were significantly lower across the three groups, with the lowest levels in endometrial cancer (14.6 ± 3.1, 11.2 ± 2.8, and 7.4 ± 2.1 pg/mL in the polyp, hyperplasia, and cancer groups, respectively; p < 0.001). GLP-1 was negatively correlated with age (ρ = −0.309, p < 0.001) and CRP (ρ = −0.293, p < 0.001), while no significant correlations were observed with HbA1c, CA-125, WBC, neutrophil, platelet, or lymphocyte counts. In multivariable analysis, increasing age (adjusted OR 1.320, 95% CI 1.159–1.503; p < 0.001) and lower GLP-1 levels (adjusted OR 0.744 per 1 pg/mL increase, 95% CI 0.636–0.871; p < 0.001) remained independently associated with endometrial cancer after adjustment for BMI, HbA1c, hypertension, CRP, and CA-125. GLP-1 demonstrated high discriminatory performance (AUC 0.94, 95% CI 0.90–0.97), with an optimal cutoff of 9.12 pg/mL, 86.0% sensitivity, and 91.6% specificity.

Conclusion

Lower serum GLP-1 levels were independently associated with endometrial cancer in obese, non-diabetic women. Although GLP-1 was negatively correlated with CRP, its association with endometrial cancer remained significant after adjustment for CRP and other relevant factors, suggesting that this relationship may not be explained solely by systemic inflammation. Serum GLP-1 may have potential as an adjunctive biomarker for risk stratification; however, prospective multicenter validation is required.