TY - JOUR
T1 - Are We Undertreating Black Patients with Nonfunctional Pancreatic Neuroendocrine Tumors? Critical Analysis of Current Surveillance Guidelines by Race
AU - Zheng-Pywell, Rui
AU - Lopez-Aguiar, Alexandra
AU - Fields, Ryan C.
AU - Vickers, Selwyn
AU - Yates, Clayton
AU - Dudeja, Vikas
AU - Chen, Herbert
AU - Reddy, Sushanth
AU - Maithel, Shishir K.
AU - Rose, J. Bart
AU - Pawlik, Timothy M.
AU - Poultsides, George
AU - Cho, Clifford S.
AU - Idrees, Kamran
AU - Rocha, Flavio G.
AU - Varley, Dr Patrick
AU - Barrett, Dr James
N1 - Funding Information:
Support: The research reported in this paper was supported by the National Cancer Institute of the National Institutes of Health under awards T32CA229102 and K08CA234209.
Publisher Copyright:
© 2022 Elsevier Inc.. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85128160767&partnerID=8YFLogxK
U2 - 10.1097/XCS.0000000000000105
DO - 10.1097/XCS.0000000000000105
M3 - Article
C2 - 35380181
AN - SCOPUS:85128160767
SN - 1072-7515
VL - 234
SP - 599
EP - 606
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 4
ER -