I. H. Ali¹, S. M. Hasan²*, N. H. Khedhir³, O. Mohsein⁴

¹Middle Technical University, Community Health Technologies Department, Iraq;
²Department of Anesthesia Techniques, College of Health
and Medical Technologies, University of Mashreq, Baghdad, Iraq;
³Department of Pharmacy, Medical Technical Institute of Kirkuk,
Northern Technical University, Community Health Technologies Department, Iraq;
⁴Department of Medical Laboratory Techniques, Mazaya University College,
Main Laboratory Unit, Thi-Qar Health Directorate, Al Habbobi Teaching Hospital, Thi-Qar, Iraq;
*e-mail: saif.hasan@uom.edu.iq

Received: 27 February 2026; Revised: 27 April 2026;
Accepted: 29 May 2026; Available on-line: 18 June 2026

Background. It is recognized that endometrial physiology and carcinogenesis depend on the balan­ce of estrogen and progesterone. Eхpression status of estrogen (ER) and progesterone (PR) receptors has been utilized clinically as a prognostic predictor of endometrial cancer (EC). Nevertheless there is growing evidence that insulin resistance and changes in adipokine secretory system are also important risk factor of EC. Objective. To investigate the association between tumor estrogen and progesterone receptors expression combined with metabolic hormone serum levels and tumor progression in patients with endometrial cancer. Methods. The study included 100 patients with endometrial cancer patients and 50 age-matched healthy controls. Serum estradiol, progesterone, insulin, leptin and adiponectin were analyzed with a chemiluminescent immunoassay. Tumor tissue samples were stained using monoclonal antibodies against ER and PR with a standard streptavidin-biotin method. Nuclear staining ≥10% was considered positive. Results. It was shown that the majority of the tumors were ER-positive (68%) and PR-positive (54%) while 27% were double-nega­tive. Serum estradiol, leptin, and insulin levels were significantly higher in advanced-stage patients, while progesterone and adiponectin levels were significantly lower compared to early-stage patients. Correlation and regression results showed that the independent variables that predicted tumor progression were ER and PR negativity, high estradiol, high leptin, and low adiponectin. Conclusions. The loss of ER/PR expression and a metabolic hormonal imbalance – characterized by elevated levels of estradiol and leptin and reduced levels of adiponectin – are closely associated with the progression of endometrial cancer. These changes may contribute to proliferative signaling pathways and inflammatory processes, leading to increased tumor aggressiveness and disease progression.