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

Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity? Journal of surgical oncology DePalo, D. K., Lee, R. M., Lopez-Aguiar, A. G., Gamboa, A. C., Rocha, F., Poultsides, G., Dillhoff, M., Fields, R. C., Idrees, K., Nathan, H., Abbott, D., Maithel, S. K., Russell, M. C., other members of the United States Neuroendocrine Tumor Study Group 2019

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 58years, 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.

View details for DOI 10.1002/jso.25662

View details for PubMedID 31385621