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

• Type of Material: Article
• Authors: Danielle K. DePalo, Emory University; Rachel M. Lee, Emory University; Alexandra G. Lopez-Aguiar, Emory University; Adriana C. Gamboa, Emory University; Flavio Rocha, Virginia Mason Medical Center; George Poultsides, Stanford University; Mary Dillhoff, Ohio State University; Ryan C. Fields, Washington University in St. Louis; Kamran Idrees, Vanderbilt University; Hari Nathan, University of Michigan; Daniel Abbott, University of Wisconsin; Shishir Maithel, Emory University; Maria Russell, Emory University
• Language: English
• Date: 2019-08-06
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.25662
• Title of Journal or Parent Work: JOURNAL OF SURGICAL ONCOLOGY
• Volume: 120
• Issue: 6
• Start Page: 919
• End Page: 925
• Keywords: Life Sciences & Biomedicine; pancreas; racial disparities; Oncology; lymph node positivity; Surgery; small bowel; neuroendocrine tumors; Science & Technology; SURVIVAL

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.