Regarding CT findings, the apoA2-i index significantly decreased with the progression of pancreatic atrophy (<i>p</i> = 0.027) and was also significantly lower in patients with pancreatic duct dilatation (<i>p</i> = 0.016).<h4>Conclusions</h4>The apoA2-i index can detect CA19-9-negative pancreatic cancer, and the combination of the apoA2-i index with CA19-9 enhances diagnostic performance in clinical practice. This evidence concerns the gene APOA2 and pancreatic neoplasm.