Alpha-Fetoprotein Is a Potential Biomarker for Pancreatic Ductal Adenocarcinoma (PDAC): A Case Report.

[INTRODUCTION] Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at an advanced stage, with high rates of mortality and drug resistance. Carbohydrate antigen 19-9 (CA19-9) is a tumor biomarker for diagnosis and prognosis in PDAC. However, elevated alpha-fetoprotein (AFP) is exceedingly rare in the PDAC patient.

[CASE PRESENTATION] Herein, we describe a 67-year-old woman who presented with elevated AFP before the diagnosis of PDAC. In March 2025, this patient who had elevated AFP and CA19-9 levels and was presenting with jaundice, was diagnosed with PDAC. Subsequently, she underwent pancreaticoduodenectomy, partial resection of the superior mesenteric vein (SMV), and SMV reconstruction. After radical resection (R0), the levels of AFP and CA19-9 were significantly decreased. Next, she was treated with adjuvant chemotherapy (gemcitabine plus capecitabine). After four cycles of treatment, the patient presented with diarrhea, weight loss, poor nutritional status, and other signs of poor tolerance to chemotherapy. Thus, the regimen was changed to pembrolizumab plus trametinib. Hepatic recurrence was detected at the 7-month follow-up. At 11 months after surgery, the patient developed a biliary tract infection and obstructive jaundice, and ultimately died.

[CONCLUSIONS] This case demonstrates that AFP may be a potential biomarker for PDAC, especially in the CA19-9-negative PDAC patient.