This study prospectively evaluated the performance of an apolipoprotein A2 isoform (ApoA2-ATQ/AT) in combination with carbohydrate antigen 19-9 (CA19-9) as early detection biomarkers for pancreatic cancer.
Using ELISA, we measured CA19-9 and ApoA2-ATQ/AT in plasma samples collected ≤60 months before diagnosis from 159 pancreatic cancer patients and 217 matched controls within the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort. The diagnostic sensitivity, specificity, and C-statistics were calculated for risk scores by strata of the time before diagnosis.
The C-statistics of CA19-9 and CA19-9+ApoA2-ATQ/AT for distinguishing pancreatic cancer patients from cancer-free individuals were 0.87 and 0.68, respectively, for samples taken ≤6 months before diagnosis, and 0.74 and 0.72, respectively, for samples taken <6 to 18 months before diagnosis. The joint diagnostic model using CA19-9+ApoA2-ATQ/AT showed significantly improved diagnostic discrimination in samples taken ≤18 months before diagnosis. Before diagnosis, the specificity of CA19-9+ApoA2-ATQ/AT was 98%, while the sensitivities of CA19-9+ApoA2-ATQ/AT were 57%, 36%, and 43%, respectively, and those of CA19-9 alone were 50%, 29%, and 36%, respectively. This joint model also showed significantly improved C-statistics for the diagnostic discrimination of samples taken >6 to 18 months (0.80 for CA19-9+ApoA2-ATQ/AT, 0.74 for CA19-9; p = 0.004) and ≤18 months (0.8 for CA19-9+ApoA2-ATQ/AT, 0.78 for CA19-9; p = 0.003) before diagnosis.
Compared to CA19-9 alone, CA19-9+ApoA2-ATQ/AT showed improved diagnostic discrimination for early detection ≤18 months before diagnosis. This plasma biomarker panel may provide a useful first measure for detecting pancreatic cancer prior to imaging. We have reported those results on behalf of the EPIC Europe.
Clinical trial identification
Legal entity responsible for the study
National Cancer Center.
Has not received any funding.
All authors have declared no conflicts of interest.