Background and Aims: The onset of pancreatic cancer is insidious and most of the patients were diagnosed at an advanced stage, thus losing the chance of radical treatment. Therefore, finding a new biomarker for the diagnosis of pancreatic cancer is of great significance. This study was conducted to investigate the association of the serum angiopoietin-like protein 2 (ANGPTL2) in pancreatic cancer patients with the clinicopathologic characteristics and its application value in diagnosis of pancreatic cancer. 
Methods: Serum ANGPTL2 levels between 125 pancreatic cancer patients and 66 healthy subjects were compared. The relations of serum ANGPTL2 level with the clinicopathologic variables and CA19-9 level as well as the risk factors for pancreatic cancer were analyzed by statistical methods. ROC curve was used to analyze the diagnostic abilities of serum ANGPTL2, serum CA19-9 and their combined detection for pancreatic cancer.
Results: The average serum level of ANGPTL2 in pancreatic cancer patients was significantly higher than that in healthy individuals (6.52 ng/mL vs. 3.78 ng/mL, P<0.05). The serum ANGPTL2 level in pancreatic cancer patients was significantly related to tumor size, histological grade, lymph node metastasis and TNM stage (all P<0.05), and irrelevant to sex, age and distant metastasis (all P>0.05). There was a significant positive correlation between serum ANGPTL2 level and CA19-9 level (r=0.772, P<0.001). Univariate and multivariate analysis showed that diabetes mellitus (P=0.016) and ANGPTL2 (P=0.014) were independent risk factors for pancreatic cancer. The AUC values of serum ANGPTL2, CA19-9 and their combined detection for diagnosis of pancreatic cancer were 0.939, 0.953 and 0.966, with the specificity/positive predictive value of 92.4%/95.7%, 84.8%/91.9%, and 98.5%/96.4%.
Conclusion: Serum ANGPTL2 level is elevated in pancreatic cancer patients. The ANGPTL2 level is closely related to the clinicopathologic features. The combined detection of ANGPTL2 and CA19-9 has certain value in diagnosis of pancreatic cancer.