ApoA2 isoforms as blood-based biomarkers reflecting pancreatic exocrine dysfunction for risk stratification and perioperative management of pancreatic cancer

Apolipoprotein A2 isoforms (apoA2‑i) are clinically validated blood‑based biomarkers for the auxiliary diagnosis of pancreatic cancer. Emerging evidence also suggests that apoA2‑i may contribute to the detection of early‑stage pancreatic cancer, particularly in cohorts where CA19‑9 shows limited sensitivity, although these applications remain investigational and require prospective validation. Beyond diagnostic applications, apoA2‑i reflect pancreatic exocrine physiology, linking biomarker biology with perioperative outcomes such as postoperative pancreatic fistula and steatotic liver disease. Because type 3c diabetes mellitus arises from exocrine dysfunction, emerging evidence suggests that exocrine‑based markers, including apoA2‑i,. may contribute to future approaches for stratifying new‑onset diabetes, although current evidence remains preliminary. By integrating validated diagnostic roles with developing translational and physiological applications, this review outlines the evolving relevance of apoA2‑i within pancreatic oncology while emphasizing the need for prospective, multi-center validation and real-world data integration.