Impact of hospital type and location on survival outcomes for patients with well-differentiated G1/G2 pancreatic neuroendocrine tumors

MD Amber L. Collier,; MD, MSPH Ahmed Alnajar,; PhD Mehmet E. Akcin,; MD Alessia C. Cioci,; MD, FACS John I. Lew,; MD Tanaz M. Vaghaiwalla; FACS

doi:10.1530/endoabs.108.C48

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Endocrine Abstracts (2024) 108 C48 | DOI: 10.1530/endoabs.108.C48

NANETS2024 17th Annual Multidisciplinary NET Medical Symposium NANETS 2024 Clinical - Surgery/Applied Pathology (9 abstracts)

Impact of hospital type and location on survival outcomes for patients with well-differentiated G1/G2 pancreatic neuroendocrine tumors

Amber L. Collier, MD¹, Ahmed Alnajar, MD, MSPH², Mehmet E. Akcin, PhD², Alessia C. Cioci, MD¹, John I. Lew, MD, FACS¹, Tanaz M. Vaghaiwalla MD & FACS¹

Author affiliations

¹Department of Surgery, Division of Endocrine Surgery, University of Miami Miller School of Medicine, Miami, FL; ²Department of Surgery, University of Miami Miller School of Medicine, Miami, FL

Background: Well-differentiated nonfunctional pancreatic neuroendocrine tumors (WD PanNETs) are rare neoplasms requiring multidisciplinary management, with treatment facility type and location impacting patient outcomes. This study evaluates how facility type, geographic distance, and treatment modality influence survival in patients with WD PanNETs.

Methods: A retrospective cohort analysis of the National Cancer Database from 2004-2021 well-differentiated G1/G2 (grade 1/grade 2) nonfunctional PanNETs. We examined demographic variables, insurance status, facility distance, pathological stage, and treatment modalities (surgery, chemotherapy, radiotherapy, hormonal therapy). Survival outcomes were analyzed through multivariable Cox proportional hazards models to assess the impact of facility type, treatment, and geography.

Results: Of the 7,556 patients, the median age was 61 years, and 46% were female. Most patients (62%) were treated at academic hospitals, followed by integrated facilities (17%) and community hospitals (21%). Most patients traveled <250 miles for treatment, while patients traveling farther were more likely to receive care at non-community hospitals. Patients treated at non-community hospitals and traveling >250 miles had the highest 15-year survival (72%) compared to those treated within 12.5 miles at community hospitals (43%, P < 0.001). Multivariable analysis demonstrated the mortality risk associated with Community hospitals with <250 miles (HR 1.22; 95% CI: 1.08–1.39, P < 0.001). Hospital volume affected survival, with low-volume centers having increased mortality risk (HR 1.34; 95% CI: 1.14–1.56, P < 0.001). Primary tumor resection was a key survival factor (HR 0.46; 95% CI: 0.40–0.53, P < 0.001). Other significant factors included age >65, male sex, no private insurance, higher comorbidity index, and G2 tumor grade.

Conclusions: Treatment at high-volume academic centers and traveling greater distances for care are associated with significantly improved survival outcomes for patients with nonfunctional PanNETs. Primary tumor resection remains a cornerstone of treatment, while systemic therapies are primarily used in later stages. These findings highlight the importance of centralized care at specialized facilities to optimize outcomes for advanced-stage PanNETs.

ABSTRACT ID28703