Racial Disparities in Clinical Features and Survival Outcomes among Patients with Pancreatic Neuroendocrine Tumor: A Contemporary SEER Database Analysis

Abstract

Objective: The characteristics of clinical features and prognoses among patients with different racial backgrounds have not been clearly studied. We thus investigated the clinical characteristics and overall survival (OS) differences among Asian, White, and Black patients with pancreatic neuroendocrine tumors (pNETs). Materials and Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with pNETs between 1983 and 2015. We performed univariable (UVA) and multivariable logistic regression (MVA) to assess the association between variables and race category. A Kaplan-Meier (KM) plot was used to calculate the OS rates. The Cox proportional hazard regression was used to report the hazard of death. Results: We identified 9,494 patients with a median follow-up of 31 months. There were 5,541 Whites (78.6%), 942 Blacks (13.4%), and 569 Asians (8.1%). Asians were more likely to be younger, married, diagnosed at an earlier stage, and have a tumor located at the head of the pancreas. White patients were less likely to be married and had, on average, a higher percentage of the primary tumor at the tail of the pancreas, while Black patients were generally diagnosed at a much later stage. The median OS of Asians (71 months) was significantly higher than that of Whites (50 months, p = 0.03) and Blacks (53 months, p = 0.01). Multivariable Cox regression showed no OS difference among the three races after adjusting for independent prognostic factors, including age, marital status, primary site, TNM stage and treatment. Subgroup analysis in each race showed that age, M stage, and surgical treatment were independent prognostic factors for survival in all three races while being female, married, and in the N0 stage were positive prognostic factors of OS only in Whites. Among patients with surgery, Asians had the best OS. Conclusions: Asians had the best OS among those who received surgery. Age, M stage, and surgical treatment were the independent prognostic factors for survival across the three races. Female, married, and in the N0 stage were positive predictive factors for survival only in White patients.