Race and income-related disparities in survival outcomes in patients with pancreatic neuroendocrine tumors: A SEER-based analysis.

Abstract

672 Background: Racial and income-related disparities in gastrointestinal (GI) cancers influence access to care and survival outcomes. While pancreatic neuroendocrine tumors (PNETs) are rare, differences in treatment and prognosis across groups remain understudied, especially for islet cell-type benign PNETs which are excluded from most studies. Evaluating race- and income-based survival patterns can highlight barriers to care and inform more equitable management strategies. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients diagnosed with PNETs between 2000–2022. Only individuals with age at diagnosis ≥15 years were included, though all patients were ≥18. Primary site codes C25.0–C25.9 and histology codes 8150/0 and 8150/3 (benign and malignant islet cell type) were analyzed. This differs from most SEER-based PNET studies, which typically restrict to malignant cases and broader histologic subtypes. Demographic variables included sex, race/ethnicity, age group (15–49, 50–64, ≥65), and county-level inflation-adjusted income quartile. Kaplan–Meier survival analysis, chi-square testing, and Cox proportional hazards regression were used to assess associations between demographics, income, and survival. Results: A total of 997 patients met inclusion (549 males, 448 females). Racial distribution was White (73.3%), Black (9.4%), Hispanic (10.2%), Asian/Pacific Islander (5.9%), and other/unknown (1.1%). Income quartiles were Q1 (7.8%), Q2 (25.1%), Q3 (37.9%), and Q4 (29.2%). Most were ≥50 years (78.5%). Chemotherapy was received by 18.9% of patients. Five-year cause-specific survival exceeded 70% overall. Survival was significantly higher in Q4 versus Q1–Q3 combined (68.3% vs 62.1%, p = 0.028). Survival differences by race were not statistically significant (p = 0.10), though numerically Asian/Pacific Islander (70.9%) and Hispanic (67.2%) patients outperformed Black patients (56.3%). Conclusions: Patients in the highest income quartile had superior survival, underscoring persistent income-related inequities in islet cell subtype PNET outcomes. Baseline characteristics show disparities, with nearly three-quarters of patients being White and fewer than 10% from the lowest income quartile. This study is unique in including both benign and malignant PNETs (8150/0, 8150/3), an understudied cohort that broadens current survival data.