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

Rui Zheng-Pywell; Alexandra Lopez-Aguiar; Ryan C Fields; Selwyn Vickers; Clayton Yates; Vikas Dudeja; Herbert Chen; Sushanth Reddy; Shishir K Maithel; J Bart Rose

doi:10.1097/XCS.0000000000000105

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

Journal article

Peer reviewed

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

Rui Zheng-Pywell, Alexandra Lopez-Aguiar, Ryan C Fields, Selwyn Vickers, Clayton Yates, Vikas Dudeja, Herbert Chen, Sushanth Reddy, Shishir K Maithel and J Bart Rose

Journal of the American College of Surgeons, Vol.234(4), pp.599-606

04/01/2022

DOI: 10.1097/XCS.0000000000000105

PMCID: PMC8988469

PMID: 35380181

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Abstract

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. 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. 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. 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.

Humans

Incidence

Lymphatic Metastasis

Neuroendocrine Tumors

Pancreatic Neoplasms - pathology

Retrospective Studies

Details

Title: Subtitle: Are We Undertreating Black Patients with Nonfunctional Pancreatic Neuroendocrine Tumors? Critical Analysis of Current Surveillance Guidelines by Race
Creators: Rui Zheng-Pywell - Emory University
Alexandra Lopez-Aguiar - Emory University
Ryan C Fields - Washington University in St. Louis
Selwyn Vickers - University of Alabama at Birmingham
Clayton Yates - Emory University
Vikas Dudeja - Emory University
Herbert Chen - Emory University
Sushanth Reddy - University of Alabama at Birmingham
Shishir K Maithel - Emory University
J Bart Rose - University of Alabama at Birmingham
Resource Type: Journal article
Publication Details: Journal of the American College of Surgeons, Vol.234(4), pp.599-606
DOI: 10.1097/XCS.0000000000000105
PMID: 35380181
PMCID: PMC8988469
NLM abbreviation: J Am Coll Surg
ISSN: 1072-7515
eISSN: 1879-1190
Grant note: T32 CA229102 / NCI NIH HHS K08 CA234209 / NCI NIH HHS
Language: English
Date published: 04/01/2022
Academic Unit: Anatomy and Cell Biology; Surgery
Record Identifier: 9985244575202771

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