Diagnostic Performance of Serum VEGF and M-CSF in Cervical Cancer and, Their Association with Stage

Cervical cancer continues to be one of the most prevalent malignancies affecting women globally. Circulating biomarkers may provide added value by complementing HPV-based screening and enhancing risk stratification. The aim of this study was to investigate vascular endothelial growth factor (VEGF) and macrophage colony-stimulating factor (M-CSF) as candidate serum biomarkers for the diagnosis and disease monitoring of cervical cancer.

In a single-center case-control study, 45 women with cervical cancer and 45 healthy controls were enrolled. Clinical variables included FIGO 2018 stage, symptoms, smoking status, and HPV vaccination status. Serum VEGF and M-CSF levels were measured using ELISA. Group and stage differences were assessed, and diagnostic performance was evaluated using ROC analysis, Youden's index, and logistic regression.

Both biomarkers were significantly elevated in cancer patients compared with controls (M-CSF: 1457 ± 582 vs. 504 ± 250 pg/mL; VEGF: 399.7 ± 136 vs. 106.7 ± 53.2 pg/mL; both p < 0.001). Concentrations increased with advancing stage (M-CSF: p = 0.0006; VEGF: p = 0.0073). Vaccinated patients exhibited lower VEGF levels (p = 0.047). Diagnostic performance was excellent (AUC: M-CSF, 0.95; VEGF, 0.97). At optimal cut-offs, VEGF achieved 95% sensitivity (95% CI: 83.1%-99.4%) and 93% specificity (95% CI: 81.3%-98.5%). The combined model (AUC: 0.974) outperformed M-CSF alone (p = 0.038). Multivariate analysis confirmed that both VEGF and M-CSF remained significant independent predictors after adjusting for age, smoking status, and HPV vaccination status.

Serum VEGF and M-CSF demonstrate diagnostic utility and stage association in cervical cancer. Their combined use enhances discriminatory power. These findings support their potential as adjunct biomarkers; however, external validation and longitudinal studies are needed.