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

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.