Model to determine risk of pancreatic cancer in patients with new-onset diabetes
Open accessAbstract
Background & aims Of patients with new-onset diabetes (NOD; based on glycemic status) older than 50 years, approximately 1% are diagnosed with pancreatic cancer (PC) within 3 years. We aimed to develop and validate a model to determine risk of PC in patients with NOD. Methods We retrospectively collected data from 4 independent and nonoverlapping cohorts of patients (N = 1,561) with NOD (based on glycemic status; data collected at date of diagnosis and 12 months previously) in the Rochester Epidemiology Project from January 1, 2000 through December 31, 2015 to create our model. The model weighed scores for 3 factors identified in the discovery cohort to be most strongly associated with PC (64 patients with PC and 192 with type 2 diabetes): change in weight, change in blood glucose, and age at onset of diabetes. We called our model Enriching New-Onset Diabetes for Pancreatic Cancer (ENDPAC). We validated the locked-down model and cutoff score in an independent population-based cohort of 1,096 patients with diabetes; of these, 9 patients (82%) had PC within 3 years of meeting the criteria for NOD. Results In the discovery cohort, the END-PAC model identified patients who developed PC within 3 years of diabetes onset (area under receiver operating characteristic curve 0.87); a score of at least 3 identified patients who developed PC with 80% sensitivity and specificity. In the validation cohort, a score of at least 3 identified 7 of 9 patients with PC (78%) with 85% specificity; the prevalence of PC in patients with a score of at least 3 (3.6%) was 4.4-fold greater than in patients with NOD. A high END-PAC score in patients who did not have PC (false positives) was often due to such factors as recent steroid use or different malignancy. An ENDPAC score no higher than 0 (in 49% of patients) meant that patients had an extremely low risk for PC. An END-PAC score of at least 3 identified 75% of patients in the discovery cohort more than 6 months before a diagnosis of PC. Conclusions Based on change in weight, change in blood glucose, and age at onset of diabetes, we developed and validated a model to determine risk of PC in patients with NOD based on glycemic status (END-PAC model). An independent prospective study is needed to further validate this model, which could contribute to early detection of PC.
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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 [103]
A model for new-onset diabetes in Minnesota using age at onset and changes in weight and blood glucose identified a 4.5% 3-year predicted risk of pancreatic ductal adenocarcinoma, with 78% sensitivity and 80% specificity (AUC 0.87).
“A model based on patients with new-onset diabetes residing in Minnesota, USA, incorporated age at onset of diabetes and changes in weight and blood glucose to identify people with a 4·5% 3-year predicted risk of developing pancreatic ductal adenocarcinoma, with 78% sensitivity and 80% specificity (AUC 0·87).103”
From Early detection of pancreatic cancer (2020) · cites this paper as [103]
Weight loss has been validated as one of three key factors predicting early-stage disease in patients with new-onset diabetes.
“weight loss has been validated as one of three key factors to predict early stage disease in patients with new-onset diabetes,103”
From Early detection of pancreatic cancer (2020) · cites this paper as [103]
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- Authors
- Sharma, A., Kandlakunta, H., Nagpal, S. J. S., Feng, Z., Hoos, W., Petersen, G. M., & Chari, S. T.
- Affiliations
- Mayo Clinic (US)
- The University of Texas MD Anderson Cancer Center (US)
- Pancreatic Cancer Action Network (US)
- Corresponding author
- Chari, Suresh T.
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 155
- Issue
- 3
- Pages
- 730-739.e3
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC6120785
- OpenAlex
- W2803190522
- Cited by
- 394
- References
- 4
- Citations by year
- 2026: 60 · 2025: 57 · 2024: 56 · 2023: 56 · 2022: 54 · 2021: 50 · 2020: 36 · 2019: 20 · 2018: 5
- FWCI
- 10.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Gastroenterology (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG034676)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK108328, U01DK108288)
- 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 cancer risk, new-onset diabetes, type 2 diabetes, risk prediction model, weight change, age at onset of diabetes, early detection, Rochester Epidemiology Project, model validation, steroid use, cancer risk, older adults, glycemic status, sensitivity and specificity
- MeSH terms
- Age Factors, Aged, Blood Glucose, Body Weight, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms, Prospective Studies, Retrospective Studies, Risk Factors, ROC Curve, Sensitivity and Specificity, Prevalence, Risk Assessment, Patient-Specific Modeling
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