Are We Undertreating Black Patients with Nonfunctional Pancreatic Neuroendocrine Tumors? Critical Analysis of Current Surveillance Guidelines by Race

• Type of Material: Article
• Authors: Rui Zheng-Pywell, University of Alabama Birmingham; Alexandra Lopez-Aguiar, Emory University; Ryan C Fields, Washington University; Selwyn Vickers, University of Alabama Birmingham; Clayton Yates, Tuskegee University; Vikas Dudeja, University of Alabama Birmingham; Herbert Chen, University of Alabama Birmingham; Sushanth Reddy, University of Alabama Birmingham; Shishir Maithel, Emory University; Bart J Rose, University of Alabama Birmingham
• Language: English
• Date: 2022-04-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/XCS.0000000000000105
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
• Volume: 234
• Issue: 4
• Start Page: 599
• End Page: 606
• Grant/Funding Information: Research reported in this paper was supported by National Cancer Institute of the National Institutes of Health under award number T32CA229102 and K08CA234209.
• Keywords: SURVIVAL; ENETS CONSENSUS GUIDELINES; Science & Technology; SIZE; Surgery; NEOPLASMS; Life Sciences & Biomedicine; MANAGEMENT

Abstract

BACKGROUND: Pancreatic neuroendocrine tumor (PNET) survival outcomes differ by race. Current recommendations for surveillance of PNETs less than 2 cm in size are based on low malignant potential and low rates of lymph node metastases (LNM). We investigated whether these guidelines are universally applicable regardless of race. STUDY DESIGN: A multi-institutional analysis of patients with resected, nonfunctional, sporadic PNETs was performed initially using the US Neuroendocrine Study Group dataset with the National Cancer Database as a validation dataset. Patients with distant metastatic disease were excluded from analysis. RESULTS: A total of 453 (388 White and 65 Black) and 5,532 patients (4,772 White and 760 Black) were analyzed in the initial and validation datasets, respectively. White patients had a low incidence of LNM in tumors of less than 2 cm in both datasets (5% and 12%, respectively), which increased with tumor size. However, the incidence of LNM in Black patients was similar in the initial and validation datasets for tumors sized less than 2 cm (23% and 21%) and 2 to 3 cm (21% and 29%). Black patients had a significantly higher incidence of LNM in tumors less than 2 cm in size in the initial and validation datasets (p < 0.01) compared with White patients. CONCLUSIONS: The current recommendation for surveillance of PNETs of less than 2 cm in size is likely based on a low rate of LNM seen in a predominantly White population. The incidence of LNM in Black patients with tumors less than 2 cm in size is clinically relevant and concerning. Current guidelines may not be universally applicable, and a more aggressive approach to resection in Black patients with small PNETs may be warranted.