A Clinical Prediction Model to Assess Risk for Pancreatic Cancer Among Patients With New-Onset Diabetes
Open accessAbstract
Background & aims Approximately 50% of all patients with pancreatic ductal adenocarcinoma (PDA) develop diabetes mellitus before their cancer diagnosis. Screening individuals with new-onset diabetes might allow earlier diagnosis of PDA. We sought to develop and validate a PDA risk prediction model to identify high-risk individuals among those with new-onset diabetes.Methods We conducted a retrospective cohort study in a population representative database from the United Kingdom. Individuals with incident diabetes after the age of 35 years and 3 or more years of follow-up after diagnosis of diabetes were eligible for inclusion. Candidate predictors consisted of epidemiologic and clinical characteristics available at the time of diabetes diagnosis. Variables with P values <.25 in the univariable analyses were evaluated using backward stepwise approach. Model discrimination was assessed using receiver operating characteristic curve analysis. Calibration was evaluated using the Hosmer-Lemeshow test. Results were internally validated using a bootstrapping procedure.Results We analyzed data from 109,385 patients with new-onset diabetes. Among them, 390 (0.4%) were diagnosed with PDA within 3 years. The final model (area under the curve, 0.82; 95% confidence interval, 0.75-0.89) included age, body mass index, change in body mass index, smoking, use of proton pump inhibitors, and anti-diabetic medications, as well as levels of hemoglobin A1C, cholesterol, hemoglobin, creatinine, and alkaline phosphatase. Bootstrapping validation showed negligible optimism. If the predicted risk threshold for definitive PDA screening was set at 1% over 3 years, only 6.19% of the new-onset diabetes population would undergo definitive screening, which would identify patients with PDA with 44.7% sensitivity, 94.0% specificity, and a positive predictive value of 2.6%.Conclusions We developed a risk model based on widely available clinical parameters to help identify patients with new-onset diabetes who might benefit from PDA screening.
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Parametric models have been developed to identify high risk of pancreatic ductal adenocarcinoma among people with new-onset diabetes or pre-diabetes, with varying predictive performance.
“Parametric models that can identify high risk for pancreatic ductal adenocarcinoma among individuals with new-onset diabetes, or new-onset pre-diabetes, have been developed, with varying predictive performances.103–106”
From Early detection of pancreatic cancer (2020) · cites this paper as [105]
The same UK model applied to people with pre-diabetes had lower accuracy (AUC 0.71) but a consistent direction of association with pancreatic ductal adenocarcinoma.
“The same model applied to individuals with pre-diabetes showed lower accuracy (AUC 0·71), but consistent direction of association with pancreatic ductal adenocarcinoma.105”
From Early detection of pancreatic cancer (2020) · cites this paper as [105]
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- Authors
- Boursi, B., Finkelman, B., Giantonio, B. J., Haynes, K., Rustgi, A. K., Rhim, A. D., Mamtani, R., & Yang, Y.-X.
- Affiliations
- Tel Aviv University (IL)
- University of Pennsylvania (US)
- Abramson Cancer Center (US)
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Yang, Yu-Xiao
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 152
- Issue
- 4
- Pages
- 840-850.e3
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC5337138
- OpenAlex
- W2560633348
- Cited by
- 202
- References
- 49
- Citations by year
- 2026: 25 · 2025: 24 · 2024: 17 · 2023: 24 · 2022: 27 · 2021: 24 · 2020: 25 · 2019: 17 · 2018: 14 · 2017: 5
- FWCI
- 6.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000003, UL1TR001878)
- National Cancer Institute (K23CA187185, R01CA177857)
- National Institute of Diabetes and Digestive and Kidney Diseases (K08DK088945, R01DK060694, P30DK050306)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Keywords
- pancreatic ductal adenocarcinoma, new-onset diabetes, risk prediction model, cancer screening, body mass index, HbA1c, proton pump inhibitors, antidiabetic drugs, smoking, alkaline phosphatase, model validation
- MeSH terms
- Age Factors, Aged, Alkaline Phosphatase, Cholesterol, Creatinine, Diabetes Mellitus, Female, United Kingdom, Glycated Hemoglobin, Hemoglobins, Humans, Hypoglycemic Agents, Male, Middle Aged, Models, Theoretical, Pancreatic Neoplasms, Predictive Value of Tests, Retrospective Studies, ROC Curve, Smoking, Body Mass Index, Risk Assessment, Area Under Curve, Carcinoma, Pancreatic Ductal, Proton Pump Inhibitors, Early Detection of Cancer
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