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. 2019 Nov;120(6):919-925.
doi: 10.1002/jso.25662. Epub 2019 Aug 6.

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

Danielle K DePalo  1 , Rachel M Lee  1 , Alexandra G Lopez-Aguiar  1 , Adriana C Gamboa  1 , Flavio Rocha  2 , George Poultsides  3 , Mary Dillhoff  4 , Ryan C Fields  5 , Kamran Idrees  6 , Hari Nathan  7 , Daniel Abbott  8 , Shishir K Maithel  1 , Maria C Russell  1 ; other members of the United States Neuroendocrine Tumor Study Group
Affiliations

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

Danielle K DePalo et al. J Surg Oncol. 2019 Nov.

Abstract

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.

Keywords: lymph node positivity; neuroendocrine tumors; pancreas; racial disparities; small bowel.

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Figures

FIGURE 1
FIGURE 1
Recurrence-free survival by race
FIGURE 2
FIGURE 2
A, Small bowel NET lymph node positivity recurrence-free survival by race. B, Pancreatic NET lymph node positivity recurrence-free survival by race. NET, neuroendocrine tumor
See this image and copyright information in PMC

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