Racial disparities in pancreatic neuroendocrine tumors survival: a SEER study

Abstract

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.

Geographic and demographic features of neuroendocrine tumors in the United States of America: A population‐based study

“…1,2 In the United States, the incidence of NETs has increased almost 6.4-fold in the last 4 decades, and this has led to a substantial economic burden on the health care system. 5,6 In a population-based study conducted in Canada, low socioeconomic status was an independent predictor of worse OS for 5619 patients with NETs. 3,4 Very few studies have looked into the potential sociodemographic disparities in patients with NETs worldwide.…”

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

“…This is contradictory to much of the available literature regarding the impact of race on outcomes . However, it is important to note that our study population is limited to patients receiving curative‐intent surgical care at select academic high‐volume institutions.…”

“…Dasari et al found that Black patients with pancreatic neuroendocrine tumors had more advanced disease at diagnosis, limited utilization of surgery, and decreased disease‐specific survival compared with patients of other races. 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.…”

“…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 …”

“…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.…”