Ettrich TJ, et al. - In this study including 39 patients with histologically proven and clearly resectable pancreatic ductal adenocarcinoma (PDAC) (recruited from the NEONAX trial) and 15 patients with benign pancreatic disease (intraductal papillary-mucinous neoplasms, IPMN) as controls, researchers tested a new biomarker combination for early PDAC, consisting of thrombospondin-2 (THBS2), CA19-9 and circulating tumor DNA (ctDNA) analysis. They observed that for all PDAC stages, a c-statistic of 0.73 and 0.78 was reported for THBS2 and CA 19-9, respectively, which were comparable. A combination of CA 19-9, THBS2 and total cfDNA amount allowed c-statistic to improve to 0.94. For all stages, the best performance was displayed by this marker combination. For stage I, stage II and stage III, 0.93, 1.00 and 0.92 were the respective c-statistics of defined PDAC stages. The biggest improvement in sensitivity and specificity was seen for stage I PDAC. Overall, with remarkable specificity, CA 19-9, THBS2 and cfDNA marker combination afforded a composite liquid biomarker for non-invasive diagnosis of early-stage PDAC.