A blood-based biomarker panel that includes aminopeptidase N (ANPEP) and polymeric immunoglobulin receptor (PIGR) may improve early detection of pancreatic ductal adenocarcinoma (PDAC), according to a study evaluating diagnostic performance across two patient cohorts.
PDAC is often diagnosed at a late stage, when treatment options are limited. Blood tests that can detect the disease earlier are therefore an area of active research.
In this study, researchers analyzed plasma samples using mass spectrometry and ELISA to identify new biomarkers. ANPEP and PIGR were found to be present at higher levels in patients with early-stage PDAC compared with healthy individuals.
The researchers then assessed how well these markers could detect PDAC, both alone and in combination with existing biomarkers – carbohydrate antigen 19-9 (CA19-9) and thrombospondin 2 (THBS2). The analysis included samples from two independent cohorts: 135 patients from the University of Pennsylvania and 537 from the Mayo Clinic, including both cancer cases and control groups.
Individually, ANPEP and PIGR showed moderate ability to distinguish early-stage PDAC from controls, with AUC values ranging from 0.78 to 0.86. Diagnostic performance improved when the markers were combined. Panels including CA19-9, THBS2, and either ANPEP or PIGR achieved higher accuracy, with AUC values up to 0.97.
The best performance was seen with a four-marker panel (CA19-9, THBS2, ANPEP, and PIGR). At a specificity of 95 percent, this panel detected 87.5 percent of early-stage (stage I/II) PDAC cases and 91.9 percent of all stages combined.
These findings highlight the value of combining multiple biomarkers to improve diagnostic accuracy. While individual markers such as CA19-9 are already used, they can lack sensitivity or be elevated in noncancer conditions. Adding ANPEP and PIGR may help improve detection, particularly in earlier stages of disease.
The study also shows that these results were consistent across two independent patient groups, which supports the reliability of the findings.
Limitations include the retrospective design and the need for further testing in prospective and prediagnostic populations to determine how the panel performs in real-world screening or early detection settings.
Overall, the study suggests that expanding plasma biomarker panels may improve early detection of pancreatic cancer, which could support earlier diagnosis and clinical decision-making.
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