Effect of treatment center volume on outcomes in gastroenteropancreatic neuroendocrine tumor patients

Abstract

Background Medical centers with varying levels of expertise treat gastroenteropancreatic neuroendocrine tumors (GEP-NETs), which are relatively rare tumors. This study assesses the impact of center volume on GEP-NET treatment outcomes. Methods We used the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare claims data. The data includes patients diagnosed between 1995 and 2010 who had no health maintenance organization (HMO) coverage, participated in Medicare parts A and B, were older than 65 at diagnosis, had tumor differentiation information, and had no secondary cancer. We identified medical centers at which patients received GEP-NET treatment (surgery, chemotherapy, somatostatin analogues, or radiation therapy) using Medicare claims data. Center volume was divided into 3 tiers – low, medium, and high – based on the number of unique GEP-NET patients treated by a medical center over 2 years. We used Kaplan-Meier curves and Cox regression to assess the association between volume and disease-specific survival. Results We identified 899 GEP-NET patients, of whom 37, 45, and 18% received treatment at low, medium volume, and high-volume centers, respectively. Median disease-specific survival for patients at low and medium tiers were 1.4 years and 5.3 years, respectively, but was not reached for patients at high volume centers. Results showed that patients treated at high volume centers had better survival than those treated in low volume centers (HR: 0.63, 95% CI: 0.4–0.9), but showed no difference in outcomes between medium and high-volume centers. Conclusions Our results suggest that for these increasingly common tumors, referral to a tertiary care center may be indicated. Physicians caring for GEP-NET patients should consider early referral to high volume centers.

Management of neuroendocrine neoplasms: conformity with guidelines in and outside a center of excellence

“…We may suppose that patients unseen by the CoE have a less severe NEN disease; indeed, in the epidemiologic data, primaries from the rectum/appendix/stomach, known to often be localized and low grade, are more common ( 15 ). In our study, the pancreas and small intestine primaries represented the majority of the cohort, as was the case in other expert centre and/or high volume centres ( 12 , 16 ). Further efforts are necessary to increase systematic presentation of NEN patients at a RENATEN MDT.…”

“…Moreover, many studies linked better survival to early involvement of a specialized team for sarcoma management ( 11 , 15 , 21 , 22 , 23 ). Regarding NEN, only one recent retrospective study indicated a link between centre volume and patient’s survival ( 16 ). More studies have, on the other hand, examined the impact of a specialized NEN MDT, leading to significant changes in patients’ management for 21–51% of those studied ( 12 , 13 ); interestingly, Zandee and coworkers reported fewer changes after specialized MDT for gastroduodenal, appendiceal and rectal NET ( 13 ), which in the present study were managed less often in the CoE.…”

Under-Representation of Racial Groups in Genomics Studies of Gastroenteropancreatic Neuroendocrine Neoplasms

“…66 A recent analysis of the SEER-Medicare database found that most patients with GEP-NENs receive surgery at medium or high-volume centers. 67 However, they also found no significant difference in the racial composition of those treated across hospital volumes. Unfortunately, this study included a relatively small sample size of patients with mixed surgically and medically treated patients research funding for early-stage investigators and trainees from under-represented groups.…”

Molecular Genomic Assessment Using a Blood-based mRNA Signature (NETest) is Cost-effective and Predicts Neuroendocrine Tumor Recurrence With 94% Accuracy

“…Recognizing that our cohort has limitations in the assessment of cost-scaling, we reviewed a broader landscape (SEER database) to assess the US potential healt hcare impact. SEER18 reported an annual incidence of 2518 NETs 11 of which ∼77% underwent surgery 30 . In this group, ∼66% have localized or “completely” resectable disease; we projected ∼1280 R0 surgical resections annually 11 .…”