<h4>Background and aims</h4>We investigated the clinical utility of the apolipoprotein A2 isoform index (apoA2-i index), a novel tumor marker for pancreatic cancer, in clinical practice, particularly for CA19-9-negative pancreatic cancer.<h4>Methods</h4>Between May 2024 and July 2025, patients who underwent abdominal computed tomography (CT) for the differential diagnosis of pancreatic diseases had their CEA, CA19-9, and apoA2-i indexes measured. This evidence concerns the gene APOA2 and familial pancreatic carcinoma.