Abstract
Background/Objectives: Endometriosis is a chronic inflammatory disease characterized by ectopic endometrial tissue growth and is strongly associated with oxidative stress; however, systemic biomarkers reflecting this stress response remain limited. Advanced glycation end products (AGEs) promote oxidative and inflammatory signaling, while sestrin 2 (SESN2) is a stress-inducible protein involved in cellular redox homeostasis. This prospective case-control study aimed to evaluate serum AGEs and SESN2 levels in women with ovarian endometrioma and to assess their diagnostic performance. Methods: A total of 80 reproductive-aged women were enrolled, including 37 patients with ultrasonographically confirmed ovarian endometrioma and 43 healthy controls. Serum AGEs and SESN2 concentrations were measured using enzyme-linked immunosorbent assay. Results: Both biomarkers were significantly elevated in patients compared with controls (AGEs: 110.11 ± 33.35 vs. 91.70 ± 41.82 ng/mL, p = 0.007; SESN2: 9.32 ± 2.59 vs. 5.57 ± 1.52 ng/mL, p < 0.001). Receiver operating characteristic analysis demonstrated modest discriminatory ability for AGEs (AUC = 0.656), whereas SESN2 showed high diagnostic accuracy (AUC = 0.893), with 87.39% sensitivity and 86.05% specificity at an optimal cut-off value. Neither AGEs nor SESN2 levels were associated with lesion size, laterality, or pain symptoms. Conclusions: These findings provide the first evidence that circulating AGEs and SESN2 are elevated in ovarian endometrioma, supporting the role of systemic oxidative stress and stress-response pathways in endometriosis. SESN2, in particular, emerges as a promising biomarker candidate for disease presence, warranting further validation in larger and more diverse endometriosis cohorts.