Introduction

Guidelines recommend resection of non-functional neuroendocrine tumors of the pancreas (NF-pNETs) that are ≥2cm in size. We compared utilization of surgery based on race.

Methods

We identified non-Hispanic White and Black patients with localized NF-pNETs ≥2cm and Charlson-Deyo score 0-1 in the NCDB (2004-2016). We compared utilization of surgery by race, adjusting for clinicodemographic variables. Overall survival was compared based on management.

Results

A total of 3459 patients were included (White=3005;Black=454). Black patients were younger (58vs63 years) and more often treated at academic facilities (65.3%vs60.3%). Overall, Black and White patients underwent surgery at similar rates (77.3%vs79.6%). When stratified by primary site, Black patients with body/tail tumors were less likely to undergo surgery (78.5%vs84.7%). On multivariable analysis, Black race was associated with a lower likelihood of surgery overall (OR 0.74,p=0.034) and in patients with body/tail tumors (OR 0.56,p=0.001). Non-operative management was associated with a higher risk of death (HR 3.19,p<0.001).

Conclusions

In a national cohort of patients with NF-pNETs meeting criteria for resection, Black race is associated with lower frequency of surgery. Operative intervention is associated with prolonged survival. Persistent racial disparities in management of a surgically curable disease should be targeted for improvement.

中文翻译：

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手术适合患者的局部、非功能性胰腺神经内分泌肿瘤的手术治疗存在种族差异

介绍

指南建议切除≥2cm 的非功能性胰腺神经内分泌肿瘤 (NF-pNET)。我们根据种族比较了手术的使用情况。

方法

我们在 NCDB (2004-2016) 中确定了局部 NF-pNETs ≥2cm 和 Charlson-Deyo 评分 0-1 的非西班牙裔白人和黑人患者。我们比较了不同种族对手术的利用情况，并根据临床人口统计学变量进行了调整。基于管理比较总生存期。

结果

共纳入 3459 名患者（白人=3005；黑人=454）。黑人患者更年轻（58 岁对 63 岁）并且更经常在学术机构接受治疗（65.3% 对 60.3%）。总体而言，黑人和白人患者接受手术的比率相似（77.3% 对 79.6%）。当按原发部位分层时，患有身体/尾部肿瘤的黑人患者接受手术的可能性较小（78.5% 对 84.7%）。在多变量分析中，黑人种族与总体手术可能性较低（OR 0.74，p=0.034）和身体/尾部肿瘤患者（OR 0.56，p=0.001）相关。非手术治疗与较高的死亡风险相关（HR 3.19，p<0.001）。

结论

在符合切除标准的 NF-pNETs 患者的全国队列中，黑人与较低的手术频率相关。手术干预与延长生存期有关。手术可治愈疾病管理中持续存在的种族差异应作为改善的目标。