CA19-9 and apolipoprotein-A2 isoforms as detection markers for pancreatic cancer: a prospective evaluation
- PMID: 30259989
- PMCID: PMC6760974
- DOI: 10.1002/ijc.31900
CA19-9 and apolipoprotein-A2 isoforms as detection markers for pancreatic cancer: a prospective evaluation
Abstract
Recently, we identified unique processing patterns of apolipoprotein A2 (ApoA2) in patients with pancreatic cancer. Our study provides a first prospective evaluation of an ApoA2 isoform ("ApoA2-ATQ/AT"), alone and in combination with carbohydrate antigen 19-9 (CA19-9), as an early detection biomarker for pancreatic cancer. We performed ELISA measurements of CA19-9 and ApoA2-ATQ/AT in 156 patients with pancreatic cancer and 217 matched controls within the European EPIC cohort, using plasma samples collected up to 60 months prior to diagnosis. The detection discrimination statistics were calculated for risk scores by strata of lag-time. For CA19-9, in univariate marker analyses, C-statistics to distinguish future pancreatic cancer patients from cancer-free individuals were 0.80 for plasma taken ≤6 months before diagnosis, and 0.71 for >6-18 months; for ApoA2-ATQ/AT, C-statistics were 0.62, and 0.65, respectively. Joint models based on ApoA2-ATQ/AT plus CA19-9 significantly improved discrimination within >6-18 months (C = 0.74 vs. 0.71 for CA19-9 alone, p = 0.022) and ≤ 18 months (C = 0.75 vs. 0.74, p = 0.022). At 98% specificity, and for lag times of ≤6, >6-18 or ≤ 18 months, sensitivities were 57%, 36% and 43% for CA19-9 combined with ApoA2-ATQ/AT, respectively, vs. 50%, 29% and 36% for CA19-9 alone. Compared to CA19-9 alone, the combination of CA19-9 and ApoA2-ATQ/AT may improve detection of pancreatic cancer up to 18 months prior to diagnosis under usual care, and may provide a useful first measure for pancreatic cancer detection prior to imaging.
Keywords: CA19-9; apolipoprotein A2; early detection; isoforms; pancreatic cancer; prospective study.
© 2018 UICC.
Conflict of interest statement
Figures


Comment in
-
Biomarkers for screening of pancreatic cancer: A risk assessment.Int J Cancer. 2019 Oct 1;145(7):2002. doi: 10.1002/ijc.32387. Epub 2019 May 15. Int J Cancer. 2019. PMID: 31054166 No abstract available.
Similar articles
-
Clinical development of a blood biomarker using apolipoprotein-A2 isoforms for early detection of pancreatic cancer.J Gastroenterol. 2024 Mar;59(3):263-278. doi: 10.1007/s00535-023-02072-w. Epub 2024 Jan 23. J Gastroenterol. 2024. PMID: 38261000 Free PMC article.
-
Clinical Significance of Plasma Apolipoprotein-AII Isoforms as a Marker of Pancreatic Exocrine Disorder for Patients with Pancreatic Adenocarcinoma Undergoing Chemoradiotherapy, Paying Attention to Pancreatic Morphological Changes.Biomed Res Int. 2019 Apr 4;2019:5738614. doi: 10.1155/2019/5738614. eCollection 2019. Biomed Res Int. 2019. PMID: 31080824 Free PMC article.
-
Potential of Carbohydrate Antigen 19-9 and Serum Apolipoprotein A2-Isoforms in the Diagnosis of Stage 0 and IA Pancreatic Cancer.Diagnostics (Basel). 2024 Aug 30;14(17):1920. doi: 10.3390/diagnostics14171920. Diagnostics (Basel). 2024. PMID: 39272705 Free PMC article.
-
From discovery to clinical implementation of a pancreatic blood biomarker, apolipoprotein A2 isoform.Cancer Biomark. 2025 Mar;42(3):18758592251317405. doi: 10.1177/18758592251317405. Epub 2025 Apr 2. Cancer Biomark. 2025. PMID: 40171807 Review.
-
Potential usefulness of apolipoprotein A2 isoforms for screening and risk stratification of pancreatic cancer.Biomark Med. 2016 Nov;10(11):1197-1207. doi: 10.2217/bmm-2016-0209. Epub 2016 Sep 27. Biomark Med. 2016. PMID: 27673558 Free PMC article. Review.
Cited by
-
Downregulation of Fat Mass and Obesity Associated (FTO) Promotes the Progression of Intrahepatic Cholangiocarcinoma.Front Oncol. 2019 May 9;9:369. doi: 10.3389/fonc.2019.00369. eCollection 2019. Front Oncol. 2019. PMID: 31143705 Free PMC article.
-
Identifying Novel Biomarkers Ready for Evaluation in Low-Prevalence Populations for the Early Detection of Upper Gastrointestinal Cancers: A Systematic Review.Adv Ther. 2021 Feb;38(2):793-834. doi: 10.1007/s12325-020-01571-z. Epub 2020 Dec 11. Adv Ther. 2021. PMID: 33306189 Free PMC article.
-
Comparative Serum Proteome Profiling of Canine Benign Prostatic Hyperplasia before and after Castration.Animals (Basel). 2023 Dec 14;13(24):3853. doi: 10.3390/ani13243853. Animals (Basel). 2023. PMID: 38136890 Free PMC article.
-
Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection.Gastroenterology. 2021 Mar;160(4):1373-1383.e6. doi: 10.1053/j.gastro.2020.11.052. Epub 2020 Dec 14. Gastroenterology. 2021. PMID: 33333055 Free PMC article. Clinical Trial.
-
Metagenomic Microbial Signatures for Noninvasive Detection of Pancreatic Cancer.Biomedicines. 2025 Apr 21;13(4):1000. doi: 10.3390/biomedicines13041000. Biomedicines. 2025. PMID: 40299688 Free PMC article.
References
-
- Modolell I, Guarner L, Malagelada JR. Vagaries of clinical presentation of pancreatic and biliary tract cancer. Ann Oncol. 1999;10(Suppl 4):82–4. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous