Impact of race on surgical management of pancreatic neuroendocrine tumors.

Julien, Jamii St.; Huo, Jinhai; Shih, Ya-Chen Tina; Grubbs, Elizabeth G.; Graham, Paul H.; Perrier, Nancy D.; Katz, Matthew H.; Yao, James C.; Lee, Jeffrey Edwin

doi:10.1200/jco.2016.34.15_suppl.e18081

Cited by 3 publications

(8 citation statements)

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“…As for those patients underwent surgery, the OS and PNSS display no significant racial disparity. However, contrary to our study, a pancreatic NETs research based on National Cancer Database reported that race was not associated with treatment choice or survival in pancreatic NETs . The possible reason may be different select criteria, and what they focused on were patients with non‐metastatic.…”

Section: Discussioncontrasting

confidence: 90%

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Racial disparities in pancreatic neuroendocrine tumors survival: a SEER study

et al. 2017

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Pancreatic neuroendocrine tumor (pancreatic NETs), is an important cause of cancer‐related death worldwide. No study has rigorously explored the impact of ethnicity on pancreatic NETs. We aimed to demonstrate the relationship between ethnicity and the survival of patients with pancreatic NETs. We used the SEER database to identify patients with pancreatic NETs from 2004 to 2013. Kaplan–Meier methods and Cox proportional hazard models were used to evaluate the impact of race on survival in pancreatic NETs patients. A total of 3850 patients were included: 3357 Non‐Blacks, 493 Blacks. We stratified races as “Black” and “White/Other.” Blacks were more likely to be diagnosed with later stages of tumors (P = 0.021). As for the treatment, the access to surgery seemed to be more limited in Blacks than non‐Black patients (P = 0.012). Compared with non‐Black patients, Black patients have worse overall survival (OS) (HR = 1.17, 95% CI: 1.00–1.37, P = 0.046) and pancreatic neuroendocrine tumors specific survival (PNSS) (HR = 1.22, 95% CI: 1.01–1.48, P = 0.044). Multivariate Cox analysis identified that disease extension at the time of diagnosis and surgical status contributed to the ethnical survival disparity. Black patients whose stages at diagnosis were localized had significantly worse OS (HR = 2.09, 95% CI: 1.18–3.71, P = 0.011) and PNSS (HR = 3.79, 95% CI: 1.62–8.82, P = 0.002). As for the patients who did not receive surgery, Blacks also have a worse OS (HR = 1.18, 95% CI: 1.00–1.41, P = 0.045). The Black patients had both worse OS and PNSS compared to non‐Black patients. The restricted utilization of surgery, and the advanced disease extension at the time of diagnosis are the possible contributors to poorer survival of Blacks with pancreatic NETs.

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Section: Discussioncontrasting

confidence: 90%

“…Julien et al. found that SES are associated with treatment choice in pancreatic NETs . Blacks are more likely to be in disadvantaged SES, and tend to cluster in low quality hospital .…”

Section: Discussionmentioning

confidence: 99%

Racial disparities in pancreatic neuroendocrine tumors survival: a SEER study

et al. 2017

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“…Zhou et al likewise reported decreased overall and disease‐specific survival for localized pancreatic neuroendocrine tumors in Black patients . In contrast, St Julien et al found that socioeconomic status and insurance coverage, but not race, were associated with variations in treatment and survival in patients with nonmetastatic pancreatic neuroendocrine tumors.…”

Section: Introductionmentioning

confidence: 99%

“…There is a large body of research regarding racial disparities in cancer outcomes and treatments, but a relatively small amount specific to neuroendocrine tumors. Available data have shown that minority race and lower socioeconomic status are associated with not only more advanced stage at diagnosis, but also with variations in treatment received and differences in outcome for neuroendocrine tumors …”

Section: Introductionmentioning

confidence: 99%

“…Most treatment and outcome disparities research for neuroendocrine tumors has been conducted by utilizing the Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB), and largely focuses on pancreatic neuroendocrine tumors . Our aim was to investigate the interaction of race with clinicopathologic variables, disease presentation, treatment patterns, and recurrence‐free survival (RFS) in GEP neuroendocrine tumors in a large multi‐institutional database.…”

Section: Introductionmentioning

confidence: 99%

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Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?

DePalo

Lee

Lopez‐Aguiar

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Although minority race has been associated with worse cancer outcomes, the interaction of race with pathologic variables and outcomes of patients with gastroenteropancreatic neuroendocrine tumors (GEP‐NETs) is not known. Methods Patients from the US Neuroendocrine Study Group (2000‐2016) undergoing curative‐intent resection of GEP‐NETs were included. Given few patients of other races, only Black and White patients were analyzed. Results A total of 1143 patients were included. Median age was 58 years, 49% were male, 14% Black, and 86% White. Black patients were more likely to be uninsured (7% vs 2%, P = .011), and to have symptomatic bleeding (13% vs 7%, P = .009), emergency surgery (7% vs 3%, P = .006), and positive lymph nodes (LN) (47% vs 36%, P = .021). However, Black patients had improved 5‐year recurrence‐free survival (RFS) (90% vs 80%, P = .008). Quality of care was comparable between races, seen by similar LN yield, R0 resections, postoperative complications, and need for reoperation/readmission (all P > .05). While both races were more likely to have pancreas‐NETs, Black patients had more small bowel‐NETs (22% vs 13%, P < .001). LN positivity was prognostic for pancreas‐NETs (5‐year RFS 67% vs 83%, P = .001) but not for small‐bowel NETs. Conclusions Black patients with GEP‐NETs had more adverse characteristics and higher LN positivity. Despite this, Black patients have improved RFS. This may be attributed to the epidemiologic differences in the primary site of GEP‐NETs and variable prognostic value of LN‐positive disease.

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Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?

Lee

DePalo

Lopez‐Aguiar

et al. 2019

JCO

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376 Background: The prognostic value of pathologic variables is not consistent for gastroenteropancreatic neuroendocrine tumors (GEP-NETs). We previously demonstrated a limited prognostic role of lymph node (LN) positivity in small bowel NETs (SBNET) compared to pancreatic NETs (panNET). Although minority race is often associated with worse cancer outcomes, the interaction of race with pathologic and oncologic outcomes of pts with GEP-NETS is not known. Methods: Pts with GEP-NETs who underwent curative intent resection at eight institutions of the US NET Study Group from 2000-16 were included. Given few pts of other races, only Black and White race pts were analyzed. Results: Of 2,182 pts, 1,143 met inclusion criteria. Median age was 58 yrs, median follow up was 3 yrs, 48% were male, 14% (n = 157) were Black, and 86% (n = 986) were White. Black pts were more likely uninsured (7 vs 2%, p = 0.005), had symptomatic bleeding (13 vs 7%, p = 0.006), required emergency surgery (7 vs 3%, p = 0.003), and had LN positive disease (47 vs 36%, p = 0.016). Despite this, Black pts had improved 5 yr recurrence free survival (RFS) compared to White pts (90 vs 80%, p = 0.008). The quality of care received was comparable between both groups, demonstrated by similar LN yield at surgery, neg margin resection rate, post-op complications, and need for reoperation or readmission (all p > 0.05). Black pts were more likely to have SBNET (22 vs 13%) and less likely to have panNET (43 vs 68%) compared to White pts (p < 0.001). Consistent with prior data, pts with LN pos panNET had decreased 5yr RFS (67 vs 83%, p = 0.001); however, for SBNET, LN involvement was not prognostic (77 vs 96%, p = 0.08). The prognostic value of LN pos disease was similar between Black and White pts in both SBNET (p = 0.34) and panNET (p = 0.95). Conclusions: Black pts with GEP-NET present with more advanced disease, including higher LN positivity. Despite this, Black pts have improved RFS compared to White pts. Although there may be delays in seeking or reaching care, Black pts received similar quality of care compared to White pts. The improved RFS seen in Black pts may be attributed to the epidemiologic differences in the site of presentation of GEP-NETs and variable prognostic value of LN pos disease.

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Impact of race on surgical management of pancreatic neuroendocrine tumors.

Cited by 3 publications

References 0 publications

Racial disparities in pancreatic neuroendocrine tumors survival: a SEER study

Racial disparities in pancreatic neuroendocrine tumors survival: a SEER study

Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?

Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?

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