2026 Volume 64 Issue 3 Pages 512-523
Objective: Early detection of pancreatic cancer requires the identification and longitudinal follow-up of high-risk individuals through health screening. This study aimed to evaluate the clinical utility of apolipoprotein A2 isoforms (APOA2-i) in a screening population.
Subjects and Methods: We retrospectively analyzed 4,404 individuals who underwent APOA2-i measurement during health checkups and 84 APOA2-i-positive individuals who subsequently received detailed imaging examinations between May 2024 and April 2025.
Results: The APOA2-i positivity rate was 5.0%. Positive individuals were independently associated with older age, lower HDL cholesterol, and lower albumin levels. Pancreatic abnormalities detected on abdominal ultrasonography (AUS) were more frequent in the positive group (4.5% vs 2.2%), and non-visualization of the pancreas was also significantly more common (10.6% vs 4.2%). Among the 84 individuals who underwent further examinations, pancreatic diseases were identified in 35.7%, including intraductal papillary mucinous neoplasm in 13.1%.
Conclusion: APOA2-i is the only blood-based biomarker capable of identifying pancreatic exocrine dysfunction, and it is useful for detecting pancreatic high-risk lesions that are difficult to identify at AUS screening alone. APOA2-i-positive individuals may represent a high-risk population for future pancreatic cancer development and require careful long-term follow-up.
