A clinical prediction model to assess risk for pancreatic cancer among patients with prediabetes
- 20 January 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in European Journal of Gastroenterology & Hepatology
- Vol. 34 (1), 33-38
- https://doi.org/10.1097/meg.0000000000002052
Abstract
Background Early detection of pancreatic ductal adenocarcinoma (PDA) may improve survival. We previously developed a clinical prediction model among patients with new-onset diabetes to help identify PDAs 6 months prior to the clinical diagnosis of the cancer. We developed and internally validated a new model to predict PDA risk among those newly diagnosed with impaired fasting glucose (IFG). Methods We conducted a retrospective cohort study in The Health Improvement Network (THIN) (1995–2013) from the UK. Eligible study patients had newly diagnosed IFG during follow-up in THIN. The outcome was incident PDA diagnosed within 3 years of IFG diagnosis. Candidate predictors were factors associated with PDA, glucose metabolism or both. Results Among the 138 232 eligible patients with initial IFG diagnosis, 245 (0.2%) were diagnosed with PDA within 3 years. The median time from IFG diagnosis to clinical PDA diagnosis was 326 days (IQR 120–588). The final prediction model included age, BMI, proton pump inhibitor use, total cholesterol, low-density lipoprotein, alanine aminotransferase and alkaline phosphatase. The model achieved good discrimination [area under the curve 0.71 (95% CI, 0.67–0.75)] and calibration (Hosmer and Lemeshow goodness-of-fit test P > 0.05 in 17 of the 20 imputed data sets) with optimism of 0.0012662 (95% CI, −0.00932 to 0.0108771). Conclusions We developed and internally validated a sequential PDA prediction model based on clinical information routinely available at the initial appearance of IFG. If externally validated, this model could significantly extend our ability to detect PDAs at an earlier stage.Keywords
This publication has 29 references indexed in Scilit:
- Diagnosis and Classification of Diabetes MellitusDiabetes Care, 2012
- Multiple imputation using chained equations: Issues and guidance for practiceStatistics in Medicine, 2010
- Standards of Medical Care in Diabetes—2010Diabetes Care, 2010
- Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelinesBMC Medical Research Methodology, 2009
- Cancer incidence in The Health Improvement NetworkPharmacoepidemiology and Drug Safety, 2009
- Prevalence and Clinical Profile of Pancreatic Cancer–Associated Diabetes MellitusGastroenterology, 2008
- Selection of important variables and determination of functional form for continuous predictors in multivariable model buildingStatistics in Medicine, 2007
- Validation studies of the health improvement network (THIN) database for pharmacoepidemiology researchPharmacoepidemiology and Drug Safety, 2006
- Diabetes management in the USA and England: comparative analysis of national surveysJournal of the Royal Society of Medicine, 2006
- Basic principles of ROC analysisSeminars in Nuclear Medicine, 1978