NET guidelines for white patients may not fit Asian patients.

Area of Science:

• Oncology
• Surgical Oncology
• Racial Disparities in Cancer Care

Background:

• Pancreatic neuroendocrine tumors (pNETs) exhibit variable survival outcomes influenced by race.
• Existing size-based treatment guidelines for pNETs were primarily established from studies on White patient populations.
• There is a need to evaluate the generalizability of these guidelines across different racial demographics.

Purpose of the Study:

• To investigate the relationship between tumor size and the incidence of lymph node metastasis (LNM) in White and Asian patients with pNETs.
• To assess the applicability of current size-based surgical resection guidelines for pNETs in a diverse patient population.
• To identify potential racial differences in pNET progression and metastasis patterns.

Main Methods:

• A multi-institutional analysis of 4977 patients with low-grade, resected, nonfunctional, sporadic, non-metastatic pNETs was conducted using the National Cancer Database (NCDB).
• Chi-squared tests and logistic regression models were used to analyze correlations between primary tumor size (PTS), race, and lymph node metastasis (LNM) incidence.
• Overall survival was evaluated using the Kaplan-Meier method.

Main Results:

• Asian patients had smaller tumors on average (3.0 cm vs. 3.9 cm) compared to White patients.
• White patients showed a higher incidence of LNM (27% vs. 19%) and a greater likelihood of R0 resection.
• While LNM incidence increased with tumor size in both groups, Asian patients exhibited a lower likelihood of LNM at tumor sizes ≥3 cm (28.2% vs. 39.5%).

Conclusions:

• Current size-based surgical guidelines for pNETs, developed predominantly in White patients, may not be universally applicable to Asian populations.
• The risk of lymph node metastasis in Asian patients with pNETs does not escalate at the same rate with increasing primary tumor size compared to White patients.
• Further research is warranted to refine pNET management strategies considering racial variations in tumor behavior.