A testing method has been developed that uses a blood test to detect about 87% of stage 1 and 2 pancreatic cancer patients and to capture precancerous lesions before they progress to cancer. It screens for pancreatic cancer, which is often detected late because early symptoms are not obvious, by using multiple biomarkers in the blood.

In particular, among patients with pancreatic cysts, who have a high risk of developing pancreatic cancer, the test detected 64.3% of “high-grade dysplasia,” a precancerous condition. Although still at the research stage, the findings suggest the potential to first identify high-risk groups requiring detailed examination through a blood test.

According to the international journal Nature Medicine on the 16th (local time), a research team led by Professor Ajay Goel at City of Hope, a U.S. cancer research and treatment institution, developed a liquid biopsy test, “PANXEON,” for the early detection of pancreatic cancer and evaluated its clinical performance. The international, multicenter, prospective biomarker study involved 1,785 participants, including pancreatic cancer patients and control subjects, in four countries: the United States, Korea, Japan, and Italy. Professor Park Joon O of Samsung Medical Center and Professor Kim Song Cheol of Asan Medical Center in Seoul also participated as co-authors.

Pancreatic cancer is typically detected late and has a low survival rate because its early symptoms are not pronounced. According to the National Cancer Information Center, the 5-year relative survival rate of pancreatic cancer patients in Korea between 2019 and 2023 was 17%. Pancreatic ductal adenocarcinoma (PDAC), which accounts for the majority of pancreatic cancers, is also difficult to detect at an early stage. The researchers noted in the paper that there is currently no clinically useful blood-based test capable of detecting early PDAC.

● How does this differ from existing blood tests for pancreatic cancer?

The best-known blood tumor marker used in the diagnosis and treatment of pancreatic cancer is CA19-9. However, using CA19-9 alone to screen for early pancreatic cancer has limitations. Levels can rise in noncancerous conditions such as pancreatitis or bile duct obstruction, and some individuals, due to genetic characteristics, do not produce sufficient CA19-9. For these reasons, it is not recommended as a screening test for pancreatic cancer in asymptomatic individuals.

PANXEON combines CA19-9 with microRNA (miRNA) information from the blood. miRNAs are small RNAs that regulate gene expression, and their expression patterns can change during the onset and progression of cancer.

The research team analyzed circulating miRNAs in the blood and miRNAs contained in “exosomes,” small vesicles secreted by cells, to construct a 10-miRNA signature associated with pancreatic cancer. They then combined this with CA19-9 levels to develop the PANXEON score, which comprehensively assesses pancreatic cancer risk. The XGBoost machine learning method was used for data analysis.

When using only the miRNA signature, the sensitivity for detecting early pancreatic cancer in the test cohort was 83.8%. PANXEON, which incorporates CA19-9, detected 86.8% of stage 1 and 2 PDAC patients. The false-positive rate—identifying individuals without cancer as having cancer—was 3.2% in the low-risk control group and 15.6% in the high-risk control group.

● Also detects 64.3% of “high-grade dysplasia,” the precancerous stage

The test also captured lesions at the precancerous stage, before progression to pancreatic cancer.

In an analysis of patients with pancreatic cysts, who are at high risk of developing pancreatic cancer, PANXEON detected 64.3% of “high-grade dysplasia.” High-grade dysplasia is a precancerous lesion in which cells have become abnormal to a degree close to cancer but have not yet invaded surrounding tissues. City of Hope explained that PANXEON demonstrated the potential to detect such precancerous pancreatic lesions.

Not all pancreatic cysts progress to pancreatic cancer. Therefore, distinguishing patients who have a high risk of progressing to cancer is crucial. PANXEON could potentially be used to identify patients who show risk signals in blood tests and then refer them for additional detailed examinations.

During treatment, miRNA signals in the blood also changed. Among 19 separately followed patients, miRNA signals decreased after chemotherapy and surgery, then rose again before cancer recurrence. However, since the result is based on only 19 patients, further validation is needed to determine whether it can be used as a test to monitor treatment response or recurrence.

PANXEON is not yet ready for use in general pancreatic cancer health screening. The false-positive rate in the high-risk control group was 15.6%. The research team believes that PANXEON could be used alongside existing tests to detect pancreatic cancer at an earlier stage. They noted that larger-scale prospective studies are required before the test can be applied in routine clinical practice.

Professor Goel said, “Pancreatic cancer is often fatal because it is frequently detected after the window for curative treatment has passed,” adding, “These results represent a step toward detecting pancreatic cancer before symptoms appear, when more treatment options remain available.”

Related paper
https://www.nature.com/articles/s41591-026-04625-x

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