Evaluation of serum and urinary angiogenic factors in patients with endometriosis

Problem: The aim of this study was to evaluate serum and urinary levels of vascular endothelial growth factors, tumor necrosis factor-α (TNF-α), and soluble fms-like tyrosine kinase (sFlt-1) in patients with endometriosis. Method of study: During surgery for pelvic pain, pelvic mass or infertility, serum and urine were collected. Of 70 patients, 46 had histology-proven endometriosis and 24 patients without endometriosis participated as controls. Results: Serum TNF-α levels and urinarysFlt-1 levels corrected for creatinine excretion were significantly increased in the endometriosis group (P = 0.001 and P = 0.011 respectively). Serum sFlt-1 levels and urinary sFlt-1 levels corrected for creatinine were significantly higher in patients with minimal-to-mild disease (P = 0.014 and P = 0.015 respectively), where serum TNF-α levels were increased in moderate-to-severe endometriosis (P < 0.001). Conclusion: The pathogenesis of minimal-to-mild endometriosis and moderate-to-severe endometriosis seems to be different. Increased sFlt-1 levels in serum and urine of minimal-to-mild disease indicate that sFlt-1 may have an important role in inhibiting angiogenic process of the disease.