Abstract
PURPOSE: Androgens are associated with the risk of endometrial carcinoma (EC). However, their roles as prognostic factors are less clear. This study aims to investigate the prognostic impact of different androgens. METHODS: We conducted a retrospective cohort study of patients who had previous endometrial sampling that showed EC between August 19, 2003, and November 4, 2015. This study included 465 patients with an average follow-up of 37 months. We examined associations between endogenous testosterone levels (total, bioavailable and free testosterone) and the clinical outcomes in patients with EC. Serum levels of bioavailable testosterone were calculated using the total testosterone level and the sex hormone-binding globulin concentration (measured by chemiluminescent and radioimmunoassays, respectively). RESULTS: Higher circulating concentrations of total and bioavailable testosterone were associated with a higher risk of type I endometrial cancer (OR = 1.015, 95% CI: 1.008-1.022; OR = 1.395, 95% CI: 1.266-1.536, respectively), but the similar association was not found in type II patients (OR = 1.009, 95% CI: 0.998-1.020; OR = 1.208, 95% CI: 0.998-1.461, respectively). However, higher levels of testosterone in EC patients correlated with favorable clinicopathological features, especially bioavailable and free testosterone. Furthermore, Kaplan-Meier survival analysis indicated that elevated bioavailable and free testosterone levels were associated a longer overall survival (P = 0.048, P = 0.036, respectively), but this trend was not statistically significant after adjustment for other prognostic factors (P = 0.312, P = 0.272, respectively). CONCLUSION: Elevated serum testosterone levels were associated with an increased risk of type I cancers. Although androgens showed certain prognostic values, they were not independent prognostic factors. Different androgenic indexes showed different clinical implications. The risk estimates could refer to total and/or bioavailable testosterone. Bioavailable and/or free indexes may be better markers for the probable prognostic effects.