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Validation of the Enriching New-Onset Diabetes for Pancreatic Cancer Model in a Diverse and Integrated Healthcare Setting

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Abstract

Background

The risk of pancreatic cancer is elevated among people with new-onset diabetes (NOD). Based on Rochester Epidemiology Project Data, the Enriching New-Onset Diabetes for Pancreatic Cancer (END-PAC) model was developed and validated.

Aims

We validated the END-PAC model in a cohort of patients with NOD using retrospectively collected data from a large integrated health maintenance organization.

Methods

A retrospective cohort of patients between 50 and 84 years of age meeting the criteria for NOD in 2010–2014 was identified. Each patient was assigned a risk score (< 1: low risk; 1–2: intermediate risk; ≥ 3: high risk) based on the values of the predictors specified in the END-PAC model. Patients who developed pancreatic ductal adenocarcinoma (PDAC) within 3 years were identified using the Cancer Registry and California State Death files. Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated.

Results

Out of the 13,947 NOD patients who were assigned a risk score, 99 developed PDAC in 3 years (0.7%). Of the 3038 patients who had a high risk, 62 (2.0%) developed PDAC in 3 years. The risk increased to 3.0% in white patients with a high risk. The AUC was 0.75. At the 3+ threshold, the sensitivity, specificity, PPV, and NPV were 62.6%, 78.5%, 2.0%, and 99.7%, respectively.

Conclusions

It is critical that prediction models are validated before they are implemented in various populations and clinical settings. More efforts are needed to develop screening strategies most appropriate for patients with NOD in real-world settings.

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Abbreviations

CI:

Confidence interval

NOD:

New-onset diabetes

END-PAC:

Enriching New-Onset Diabetes for Pancreatic Cancer

PDAC:

Pancreatic ductal adenocarcinoma

KPSC:

Kaiser Permanente Southern California

SEER:

Surveillance, Epidemiology, and End Results

ICD-9-CM:

Ninth Revision of International Classification of Diseases, Clinical Modification

ICD-10-CM:

Tenth Revision of International Classification of Diseases, Clinical Modification

AUC:

Area under the curve

PPV:

Positive predictive value

NPV:

Negative predictive value

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Funding

Research reported in this publication was supported by the American Pancreatic Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Pancreatic Association.

Author information

Authors and Affiliations

  1. Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, 2nd Floor, Pasadena, CA, 91101, USA

    Wansu Chen, Rebecca K. Butler & Eva Lustigova

  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Suresh T. Chari

  3. Department of Gastroenterology, Center for Pancreatic Care, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA, USA

    Bechien U. Wu

Authors
  1. Wansu Chen
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  2. Rebecca K. Butler
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  3. Eva Lustigova
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  4. Suresh T. Chari
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  5. Bechien U. Wu
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Contributions

W.C led the study design/data interpretation/manuscript preparation and obtained funding. R.K.B conducted data analyses and participated in the study design/data interpretation/manuscript preparation. E.L participated in the study design/data interpretation. S.T.C provided detailed information regarding the END-PAC model to help the design and the interpretation of the current study. B.U.W participated in the study design/data interpretation/manuscript preparation and provided clinical guidance. All the authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Wansu Chen.

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Conflict of interest

The authors declare they have not conflict of interest for this study.

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Appendices

Appendix 1

See Table 5.

Table 5 Parameters for the ENC-PAC score (Model C).
Full size table

Appendix 2: ICD-O-3 Histology Codes Used to Identify Pancreatic Ductal Adenocarcinoma (PDAC)

Please refer to the Web site for information on the histology codes.

https://www.naaccr.org/wp-content/uploads/2018/01/Updated-Jan-10-2018-ICD-O-3-Guidelines-v2.pdf.

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Chen, W., Butler, R.K., Lustigova, E. et al. Validation of the Enriching New-Onset Diabetes for Pancreatic Cancer Model in a Diverse and Integrated Healthcare Setting. Dig Dis Sci 66, 78–87 (2021). https://doi.org/10.1007/s10620-020-06139-z

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  • DOI: https://doi.org/10.1007/s10620-020-06139-z

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