Background: Early detection of pancreatic cancer using existing tumor markers is challenging, and novel biomarkers are needed. Apolipoprotein A2 (APOA2), which is not directly produced by tumors, may help detect pancreatic cancer through mechanisms distinct from carbohydrate antigen 19-9 (CA 19-9). This study aimed to evaluate the diagnostic performance of the APOA2-isoform (APOA2-i) Index in patients with pancreatic cancer.Methods: Serum levels of the APOA2-i Index and CA 19-9 were measured in 76 patients with pancreatic cancer (Stage 0, n = 5; I, n = 4; II, n = 15; III, n = 19; and IV, n = 33) and 98 patients with non-pancreatic cancer (intraductal papillary mucinous neoplasm, n = 36; chronic pancreatitis, n = 33; pancreatic neuroendocrine neoplasm, n = 8; autoimmune pancreatitis, n = 9; and others, n = 12) to evaluate diagnostic performance.Results: APOA2 showed lower accuracy for advanced (stages II–IV) pancreatic cancer compared to CA 19-9 (sensitivity, 50.7% vs. 83.6%; sensitivity, 77.6% vs. 87.9%), but it provided superior accuracy for early-stage (stages 0 and I) detection (sensitivity, 33.3% vs. 22.2%; specificity, 66.7% vs. 59.4%). Three early-stage pancreatic cancer cases negative for CA 19-9 were detected with the APOA2-i Index, demonstrating high diagnostic accuracy for early-stage pancreatic cancer when both biomarkers are combined (sensitivity, 44.4%; specificity, 46.7%). The multivariate analysis revealed pancreatic cancer to be an independent risk factor for APOA2-i Index positivity (odds ratio [OR]: 3.48,p< 0.001), CA 19-9 positivity (OR: 25.5,p< 0.001), and positivity for either marker (OR: 13.3,p< 0.001).Conclusions: The APOA2-i Index, combined with CA 19-9, may improve early-stage pancreatic cancer detection, especially in challenging cases and for high-risk patient surveillance.
背景：利用现有肿瘤标志物早期检测胰腺癌具有挑战性，需要新型生物标志物。载脂蛋白A2（APOA2）并非由肿瘤直接产生，可能通过不同于糖类抗原19-9（CA 19-9）的机制辅助胰腺癌检测。本研究旨在评估APOA2亚型（APOA2-i）指数在胰腺癌患者中的诊断效能。 方法：检测76例胰腺癌患者（0期5例、I期4例、II期15例、III期19例、IV期33例）和98例非胰腺癌患者（导管内乳头状黏液性肿瘤36例、慢性胰腺炎33例、胰腺神经内分泌肿瘤8例、自身免疫性胰腺炎9例及其他12例）的血清APOA2-i指数与CA 19-9水平，评估其诊断效能。 结果：对于进展期（II–IV期）胰腺癌，APOA2的诊断准确性低于CA 19-9（灵敏度：50.7% vs. 83.6%；特异度：77.6% vs. 87.9%），但对早期（0期和I期）胰腺癌的检测准确性更优（灵敏度：33.3% vs. 22.2%；特异度：66.7% vs. 59.4%）。3例CA 19-9阴性的早期胰腺癌病例通过APOA2-i指数被检出，当联合使用两种标志物时对早期胰腺癌显示出较高的诊断准确性（灵敏度44.4%，特异度46.7%）。多变量分析显示，胰腺癌是APOA2-i指数阳性（比值比[OR]：3.48，p<0.001）、CA 19-9阳性（OR：25.5，p<0.001）及任一标志物阳性（OR：13.3，p<0.001）的独立危险因素。 结论：APOA2-i指数与CA 19-9联合应用可提高早期胰腺癌的检出率，尤其适用于疑难病例和高危人群监测。
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