TNF and pancreatic neoplasm: Although CA19-9 is a marker of pancreatic tumors, external factors such as jaundice and other inflammatory factors can influence its accuracy.[17,18] D-dimer and TNFAIP3/A20 have also been studied in cancer.[11,16] As a stress response gene in endothelial cells (ECs), TNFAIP3/A20 has a protective effect against tumor necrosis factor (TNF)-mediated apoptosis, and inhibits inflammation.[19,20] D-dimer level is associated with vascular EC injury.[21] A relationship between TNFAIP3/A20, D-dimer and CA19-9 may hence exist.