Facility type and size-stratified analysis of management patterns and outcomes of patients with localized non-functional pancreatic neuroendocrine tumors.

Abstract

Non-functional neuroendocrine tumors of the pancreas (NF-pNETs) are uncommon. Consensus guidelines have conflicting recommendations. We performed a nationwide analysis of patterns in management and outcomes based on facility type and tumor size. The National Cancer Database (2004-2016) was queried for patients with localized NF-pNETs (<1cm, 1-2cm, >2cm) stratified by facility type. Management decisions, operative outcomes, and survival were compared. A total of 7170 patients were included in the analysis (<1cm=916; 1-2cm=2180; >2cm=4074). Most patients were treated at academic facilities (62.8%). Over 67% of patients with tumors <1cm underwent resection, independent of facility type (p=0.443). There was no association between facility type and operative vs non-operative management of patients with NF-pNETs 1-2cm in size. Patients treated at academic facilities were more likely to undergo resection for tumors >2cm compared to other facility types. Resection was associated with improved survival among patients with tumors 1-2cm (HR=0.43,p<0.001) and >2cm (HR=0.32,p<0.001), but not <1cm (HR=0.64,p=0.054), as compared to non-operative management. There is heterogeneity in management of NF-pNETs across facility types. Treatment at academic facilities appears to be associated with higher resection rates for tumors >2cm. There appears to be an independent association between operative management and improved survival for tumors ≥1cm in size.