Background

The National Institute for Health and Care Excellence (NICE) recommends that people aged 60+ years with newly diagnosed diabetes and weight loss undergo abdominal imaging to assess for pancreatic cancer. More nuanced stratification could lead to enrichment of these referral pathways.

Methods

Population-based cohort study of adults aged 30–85 years at type 2 diabetes diagnosis (2010–2021) using the QResearch primary care database in England linked to secondary care data, the national cancer registry and mortality registers. Clinical prediction models were developed to estimate risks of pancreatic cancer diagnosis within 2 years and evaluated using internal–external cross-validation.

Results

Seven hundred and sixty-seven of 253,766 individuals were diagnosed with pancreatic cancer within 2 years. Models included age, sex, BMI, prior venous thromboembolism, digoxin prescription, HbA1c, ALT, creatinine, haemoglobin, platelet count; and the presence of abdominal pain, weight loss, jaundice, heartburn, indigestion or nausea (previous 6 months). The Cox model had the highest discrimination (Harrell’s C-index 0.802 (95% CI: 0.797–0.817)), the highest clinical utility, and was well calibrated. The model’s highest 1% of predicted risks captured 12.51% of pancreatic cancer cases. NICE guidance had 3.95% sensitivity.

Discussion

A new prediction model could have clinical utility in identifying individuals with recent onset diabetes suitable for fast-track abdominal imaging.

中文翻译：

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预测成人新发糖尿病患者患胰腺癌的风险：临床风险预测模型的开发和内外部验证

背景

美国国家健康与护理卓越研究所 (NICE) 建议 60 岁以上新诊断出糖尿病且体重减轻的人接受腹部影像学检查以评估是否患有胰腺癌。更细致的分层可能会丰富这些转诊途径。

方法

使用英格兰 QResearch 初级保健数据库与二级保健数据、国家癌症登记处和死亡率登记处相关联，对 30-85 岁诊断为 2 型糖尿病的成年人（2010-2021 年）进行基于人群的队列研究。开发临床预测模型来估计 2 年内诊断胰腺癌的风险，并使用内部-外部交叉验证进行评估。

结果

2 年内，253,766 人中有 767 人被诊断患有胰腺癌。模型包括年龄、性别、BMI、既往静脉血栓栓塞史、地高辛处方、HbA1c、ALT、肌酐、血红蛋白、血小板计数；是否存在腹痛、体重减轻、黄疸、胃灼热、消化不良或恶心（过去 6 个月）。 Cox 模型具有最高的辨别力（Harrell 的C指数 0.802（95% CI：0.797–0.817））、最高的临床实用性，并且经过良好校准。该模型预测风险最高的 1% 涵盖了 12.51% 的胰腺癌病例。 NICE 指南的敏感性为 3.95%。

讨论

一种新的预测模型可能具有临床实用性，可用于识别适合快速腹部成像的新近发病的糖尿病患者。