Racial Differences in Gastroenteropancreatic Neuroendocrine Tumor Treatment and Survival in the United States

Abstract

ObjectivesThe objective of this study was to evaluate racial differences in cancer treatment and survival in gastroenteropancreatic neuroendocrine tumor (GEP-NET) patients.MethodsUsing the Surveillance, Epidemiology, and End Results Registry, we identified patients with GEP-NETs of the stomach, small intestine (SI), colon, rectum, appendix, and pancreas diagnosed between 1973 and 2014. Demographic, cancer, and treatment information were collected and compared using χ2tests. Multivariable logistic and Cox regression were used to determine disparities in receiving treatment and overall survival.ResultsWe identified 19,031 GEP-NET patients: 2839 were non-Hispanic Blacks, 12,832 non-Hispanic Whites, 2098 Hispanics, and 1262 Asians. African Americans and Hispanics with SI and pancreatic NETs were less likely to be treated with surgery (odds ratio, 0.6; 95% confidence interval [CI], 0.46–0.69; odds ratio, 0.71; 95% CI, 0.51–0.99, respectively). African American race was not an independent predictor of survival; there was a strong trend in stomach, SI, and pancreas NETs (hazard ratio [HR], 1.31; 95% CI, 1–1.7; HR, 1.2; 95% CI, 0.99–1.45; HR, 1.22; 95% CI, 1–1.48, respectively).ConclusionsOur study provides evidence of racial disparities in treatment and survival across GEP-NET primary sites and racial groups. Further studies should be performed to improve our understanding of the reason for these disparities.

Update on Epidemiology, Diagnosis, and Biomarkers in Gastroenteropancreatic Neuroendocrine Neoplasms

“…Notably, Kessel et al have reported similar racial disparities in the US; rectal NENs were more likely to occur in Asians and African Americans, but less likely to occur in Whites. In contrast, small intestinal NENs were common in Whites, African Americans, and Hispanics but rare in Asians [ 27 ]. This phenomenon suggests that there might be an association between genetic background and the biological characteristics of GEP-NENs.…”

“…USA: United States of America. Data for the figure is based on references [ 12 , 16 , 17 , 18 , 21 , 22 , 23 , 27 ].…”

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

“…2 Most GEP-NENs are diagnosed between the ages of 55 and 69, although colonic NENs peak after age 70. 3 However, across all GEP-NENs, White patients are diagnosed at significantly older ages compared to all other ethnoracial groups. Notably, an analysis of the SEER database found that the incidence of GEP-NEN varies significantly among ethnoracial groups, occurring more frequently in Black patients (5.19 cases per 100,000 individuals) compared to other ethnoracial groups (White 3.05; ethnically Hispanic/Latinx 2.46; others 2.39).…”

“…4 Additional analyses have found significant differences in the rate of metastatic disease among racial groups, with Black patients having the highest rate of advanced stage/metastatic disease in pancreatic, gastric, and appendiceal, NENs (36.3%, 20.9%, and 13.5%), followed by White patients (34% 16.7%, 12.1%), Hispanic/Latinx patients (28.2%, 15.1%, 5.65%), and Asian patients (26.7%, 16.7%, 19.8%). 3 Interestingly, White patients presented with significantly more advanced stage disease in small intestine, colon, and rectal NENs (25%, 40%, 11.3%) than ethnically Hispanic/Latinx patients (25.6%, 27.5%, 6.5%), Black (18.1%, 35.3%, 7.2%), and Asian patients (18.8%, 35.3%, 6.5%), raising questions as to the etiology of these differences in GEP-NENs of various primary sites. 3 Regarding clinical outcomes, recent work has uncovered alarming disparities between White and minority GEP-NEN patients-particularly Black patients.…”

“…3 Interestingly, White patients presented with significantly more advanced stage disease in small intestine, colon, and rectal NENs (25%, 40%, 11.3%) than ethnically Hispanic/Latinx patients (25.6%, 27.5%, 6.5%), Black (18.1%, 35.3%, 7.2%), and Asian patients (18.8%, 35.3%, 6.5%), raising questions as to the etiology of these differences in GEP-NENs of various primary sites. 3 Regarding clinical outcomes, recent work has uncovered alarming disparities between White and minority GEP-NEN patients-particularly Black patients. 3,5,6 Black patients with pNENs are more likely to be diagnosed with late-stage disease, undergo curative surgery less frequently, and have a 20% worse overall survival than White patients.…”