Hasegawa Yuta, Itokawa Norio, Kashiro Ayumi, Kitamura Michika, Nagashima Kengo, Suzuki Kenta, Higashi Tetsuyuki, Shioda-Koyano Kaori, Ono Hiroki, Kawano Tadamichi, Yoshida Yuji, Okubo Tomomi, Arai Taeang, Hayama Korenobu, Kaneko Keiko, Atsukawa Masanori, Takeuchi Keiko, Futagami Seiji, Iwakiri Katsuhiko, Honda Kazufumi
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan.
Department of Bioregulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Clin Transl Gastroenterol. 2025 May 12;16(6):e00856. doi: 10.14309/ctg.0000000000000856. eCollection 2025 Jun 1.
High-risk stigmata (HRS) and worrisome features (WFs) are imaging findings that reflect malignant potential of intraductal papillary mucinous neoplasms (IPMNs). The aim of this study was to determine the potential utility of stratifying malignant potential of IPMNs using apolipoprotein-A2 isoforms (apoA2-i) as a blood biomarker.
A total of 212 patients with IPMNs diagnosed by either magnetic resonance cholangiopancreatography or contrast-enhanced computed tomography, and endoscopic ultrasound were retrospectively enrolled. ApoA2-i and CA19-9 of all patients and 295 healthy individuals were measured. The distributions of apoA2-i and CA19-9 were analyzed in association with the malignant potential evaluated by imaging.
In 212 patients with IPMN, 17 had HRS (HRS group), 70 had WFs (WF group), and 125 had no endoscopic ultrasound findings of HRS or WFs (non-WF group). The median of the apoA2-i Index in the HRS, WF, non-WF, and healthy groups were 57.7, 72.4, 87.5, and 87.9 μg/mL, respectively, with significantly lower levels in the HRS and WF groups ( P < 0.001). By contrast, CA19-9 showed no significant difference among the 4 groups. The area under the curve of the apoA2-i Index to differentiate patients in the HRS and WF groups from the non-WF group was significantly higher than that of the CA19-9 (0.676 vs 0.554, P = 0.029).
The diagnostic performance of apoA2-i for detecting IPMN with malignant potential was superior to that of CA19-9. The apoA2-i Index could serve as a useful biomarker for risk stratification and surveillance of IPMNs.
高危征象（HRS）和可疑特征（WFs）是反映导管内乳头状黏液性肿瘤（IPMNs）恶性潜能的影像学表现。本研究的目的是确定使用载脂蛋白A2异构体（apoA2-i）作为血液生物标志物对IPMNs恶性潜能进行分层的潜在效用。
回顾性纳入212例经磁共振胰胆管造影或对比增强计算机断层扫描及内镜超声诊断为IPMNs的患者。测量所有患者及295名健康个体的apoA2-i和CA19-9。分析apoA2-i和CA19-9的分布与影像学评估的恶性潜能之间的关系。
212例IPMN患者中，17例有HRS（HRS组），70例有WFs（WF组），125例内镜超声未发现HRS或WFs（非WF组）。HRS组、WF组、非WF组和健康组的apoA2-i指数中位数分别为57.7、72.4、87.5和87.9μg/mL，HRS组和WF组水平显著较低（P<0.001）。相比之下，CA19-9在4组之间无显著差异。apoA2-i指数区分HRS组和WF组患者与非WF组患者的曲线下面积显著高于CA19-9（0.676对0.554，P=0.029）。
apoA2-i检测具有恶性潜能的IPMN的诊断性能优于CA19-9。apoA2-i指数可作为IPMNs风险分层和监测的有用生物标志物。
