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

DePalo, Danielle; Lee, Rachel; Lopez‐Aguiar, Alexandra G.; Gamboa, Adriana C.; Rocha, Flavio G.; Poultsides, George A.; Dillhoff, Mary; Fields, Ryan C.; Idrees, Kamran; Nathan, Hari; Abbott, Daniel E.; Maithel, Shishir K.; Russell, Maria C.

doi:10.1002/jso.25662

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…However, the accuracy and e ciency of the AJCC tumor staging system for patients with PNETs remain doubtful [8]. In recent years, several studies have demonstrated that additional risk factors, including age, sex, race, primary tumor site, and gene mutations, should be included in a novel prognostic indicator system for PNET patients [8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Survival Nomograms for Patients with Pancreatic Neuroendocrine Tumors: A Population-based Study

Lin

Chen

et al. 2020

Preprint

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Background: Although pancreatic neuroendocrine tumors (PNETs) are considered indolent tumors, most patients are diagnosed at an advanced stage. We aimed to establish a nomogram for clinical use to predict the survival of PNET patients using the Surveillance, Epidemiology, and End Results (SEER) database.Methods: Based on the SEER database, 1,103 patients with PNETs were enrolled and randomly divided into training and validation sets. We performed Kaplan-Meier analysis and Cox proportional hazard regression analysis in the training set to evaluate the value of the prognostic factors. A nomogram was then constructed to analyze these independent prognostic factors for predicting the overall survival (OS) and specific cancer survival (CSS). C-index, calibration curve, and decision curve analysis were used to evaluate the predictive accuracy of the nomogram.Results: Age, primary site, TNM stage, grade, and surgery were associated with OS and CSS in the multivariate models. Nomograms were established depending on these risk factors and had a better discrimination power than the TMN stage. The validation techniques showed that the nomograms were able to predict the 3- and 5-year OS and CSS accurately, and also proved to be superior.Conclusions: Nomograms were established depending on these risk factors and had a better discrimination power than the TMN stage. The validation techniques showed that the nomograms were able to predict 3- and 5-year OS and CSS accurately, and also proved to be superior.

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Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Survival Nomograms for Patients with Pancreatic Neuroendocrine Tumors: A Population-based Study

Lin

Chen

et al. 2020

Preprint

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“…Existing studies looking at racial disparities in PNETs found that Black patients had more advanced disease on presentation, a higher rate of emergent surgery, and worse OS. 11,12 However, these prior studies had limited ability to investigate socioeconomic influences. Within this study, we evaluated several socioeconomic factors that are known to impact oncologic outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…6,11 Another study analyzing patient data in the US Neuroendocrine Study Group database found that Black patients were significantly more likely to require emergent surgery or have lymph node metastases but had a better 5-year disease-free survival (DFS). 12 These findings point to an underlying racial disparity, but it is uncertain whether these differences are due to disease biology or socioeconomic circumstances. The intersection of socioeconomic factors and neuroendocrine tumor outcomes has been studied in multiple large data sets, predominantly comparing urban with rural patients.…”

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confidence: 99%

“…13 Although Black patients comprised 12.8% to 13.7% of patients in the database studies, 24.5% of our patients were Black due to our unique position as the sole comprehensive cancer center in a state with one of the largest African American populations. 6,11,12 In addition, although 59.0% of the Alabama state population is located in urban areas, 95.6% of the state land area is rural. 16 Thus, given our unique position of having a higher Black patient representation and a large rural patient referral region, we hoped to determine if we similarly noticed racial differences in patient outcomes.…”

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confidence: 99%

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Prognostic Impact of Tumor Size on Pancreatic Neuroendocrine Tumor Recurrence May Have Racial Variance

et al. 2021

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The incidence of pancreatic neuroendocrine tumors (PNETs) has increased over the last decade. Black patients have worse survival outcomes. This study investigates whether oncologic outcomes are racially disparate at a single institution.Methods: Retrospective analysis was performed on 151 patients with resected PNETs between 2010 and 2019.Results: More White males and Black females presented with PNETs (P = 0.02). White patients were older (65 years vs 60 years; P = 0.03), more likely to be married (P < 0.01), and had higher median estimated yearly incomes ($28,973 vs $17,767; P < 0.01) than Black patients. Overall and disease-free survival were not different. Black patients had larger median tumor sizes (30 mm vs 23 mm; P = 0.02). Tumor size was predictive of recurrence only for White patients (hazard ratio, 1.02; P = 0.01). Collectively, tumors greater than 20 mm in size were more likely to have recurrence (P = 0.048), but this cutoff was not predictive in either racial cohort independently.Conclusions: Black patients undergoing curative resection of PNETs at our institution presented with larger tumors, but that increased size is not predictive of disease-free survival in this population.

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“…They compared the non-Hispanic White and non-Hispanic Black patients only and did not include the Hispanic patient population. It showed better disease-free survival in non-Hispanic Black patients despite having a higher lymph node involvement [ 20 ]. Another study from Shen et al, used SEER and SEER-Medicare databases to describe racial differences in the incidence and survival of patients with all distant stage neuroendocrine tumors.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Disparities and Survival Characteristics in Non-Pancreatic Gastrointestinal Tract Neuroendocrine Tumors

Goksu

Özer

Beg

et al. 2020

Cancers

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Background: We studied the effect of race and ethnicity on disease characteristics and survival in gastrointestinal neuroendocrine tumors. Methods: The Surveillance, Epidemiology, and End Results database was used to select patients with non-pancreatic gastrointestinal neuroendocrine tumors diagnosed between 2004 and 2015. Trends in survival were evaluated among three groups: Hispanic, non-Hispanic White, and non-Hispanic Black. Kaplan–Meier and Cox regression methods were performed to calculate overall survival and cause-specific survival after adjusting for patient and tumor characteristics. Results: A total of 26,399 patients were included in the study: 65.1% were non-Hispanic White, 19.9% were non-Hispanic Black, and 15% were Hispanic. Non-Hispanic White patients were more likely to be male (50.0%, p < 0.001), older than 60 years (48.0%, p < 0.001), and present with metastatic disease (17.7%, p < 0.001). Non-Hispanic White patients had small intestine neuroendocrine tumors, while Hispanic and non-Hispanic Black patients had rectum neuroendocrine tumors as the most common primary site. Hispanic patients had better overall survival, while non-Hispanic Black patients had better cause-specific survival versus non-Hispanic White patients. This finding was confirmed on multivariable analysis where Hispanic patients had improved overall survival compared to non-Hispanic White patients (Hazard ratio (HR): 0.89 (0.81–0.97)), whereas non-Hispanic Black patients had better cause-specific survival compared to non-Hispanic White patients (HR: 0.89 (0.80–0.98)). Conclusions: Race/ethnicity is an independent prognostic factor in patients with gastrointestinal neuroendocrine tumors.

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

Cited by 12 publications

References 14 publications

WITHDRAWN: Survival Nomograms for Patients with Pancreatic Neuroendocrine Tumors: A Population-based Study

WITHDRAWN: Survival Nomograms for Patients with Pancreatic Neuroendocrine Tumors: A Population-based Study

Prognostic Impact of Tumor Size on Pancreatic Neuroendocrine Tumor Recurrence May Have Racial Variance

Racial/Ethnic Disparities and Survival Characteristics in Non-Pancreatic Gastrointestinal Tract Neuroendocrine Tumors

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