The diagnostic utility of fibroblast activating protein (FAP) alpha in relation to transforming growth factor (TGF) beta and beta catenin immunohistochemical markers in pancreatic adenocarcinoma versus pancreatitis

Pancreatic adenocarcinoma and chronic pancreatitis may present complex challenges in diagnosis due to overlapping clinical and histopathological features. Pancreatic adenocarcinoma is a particularly lethal neoplasm with a grim 5% overall 5-year survival rate. Recent research underscores the pivotal role of the tumor microenvironment in neoplastic initiation and progression, with stromal components supporting tumor growth, invasion, and metastasis. Fibroblast Activation Protein alpha (FAPα) and TGF-beta have been identified as significant players in this context. This study collected paraffin blocks from 32 patients with pancreatic adenocarcinoma and 11 patients with chronic pancreatitis to investigate the expression and localization of FAPα in relation to TGF-beta, and B-Catenin expressions. Both patient groups revealed a higher prevalence of males, but no statistically significant gender difference. Notably, age emerged as a crucial distinguishing factor, with pancreatic adenocarcinoma patients being notably older. Biomarker analysis showed that B-Catenin was the superior diagnostic marker, detecting 68.6% of cases, particularly in late stages, and exhibiting a positive relationship with tumor size and spread. FAP α plays a critical role in early detection, identifying 40.6% of cases and showing a weak negative relationship with tumor size and spread. Combining B-Catenin and FAP α proved to be the most effective approach, detecting all cases with variable intensity. These findings have significant implications for improving early and accurate diagnosis, which can lead to more tailored management, however further research is still needed to validate and refine diagnostic approaches as our understanding of these diseases evolves.