Sex-specific prediction models help estimate pancreatic ductal adenocarcinoma risk in diabetes

The risk of pancreatic ductal adenocarcinoma (PDAC) appears to be higher among individuals with diabetes than in the general population, as well as in men than women, according to a study. Prediction models built around this finding demonstrate moderate accuracy for pinpointing men at high risk of PDAC, in whom surveillance may be required.

The study used data from the Veterans Affairs Health System and identified three cohorts of individuals with progression of diabetes: insulin initiators (n=449,685), initiators of combination oral hypoglycaemic treatment (n=414,460), and individuals with haemoglobin A1c (HbA1c) ≥8 percent with a change of ≥1 percent within 15 months (n=593,401).

Researchers calculated 12-, 36-, and 60-month incidence of PDAC and developed prediction models separately for males and females based on >30 demographic, behavioural, clinical, and laboratory variables. Models were selected to optimize Akaike's Information Criterion, and predictive performance for incident PDAC was evaluated by bootstrap.

PDAC occurred with the greatest frequency among insulin initiators and more frequently in men than in women. The median age of those who developed PDAC ranged 65.2–66.2 years in men and 60.5–61.2 years in women.

In the male population, optimism-corrected c-indices of the models for predicting the 36-month incidence of PDAC were 0.72, 0.70, and 0.71. The models performed better for predicting 12-month incident PDAC (c-index: 0.78, 0.73, 0.76) and worse for predicting 60-month incident PDAC (c-index: 0.69, 0.67, 0.68). In the female population, on the other hand, the predictive performance of the models was lower.

For individuals whose model-predicted 36-month PDAC risks were ≥1 percent, the observed incidences were 1.9 percent, 2.2 percent, and 1.8 percent.

The findings show that the models can identify patients with diabetes progression who would benefit from PDAC screening.