Demographic and Survival Outcomes in Early-Onset Pancreatic Neuroendocrine Tumors: A National Cancer Database Study

Nwankwo, Jr. MD, MS Eugene C; MS Courtney Day,; MD Vinay Chandrasekhara; MD Jad P AbiMansour,

doi:10.1530/endoabs.116.P9

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Endocrine Abstracts (2025) 116 P9 | DOI: 10.1530/endoabs.116.P9

NANETS2025 18th Annual Multidisciplinary NET Medical Symposium NANETS 2025 Population Science Section (10 abstracts)

Demographic and Survival Outcomes in Early-Onset Pancreatic Neuroendocrine Tumors: A National Cancer Database Study

Eugene C Nwankwo, Jr. MD, MS¹, Courtney Day, MS², Vinay Chandrasekhara MD¹ & Jad P AbiMansour, MD¹

Author affiliations

¹Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA; ²Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA

Background: Pancreatic neuroendocrine tumors (pNETs) have been observed in younger adults, though epidemiologic trends remain poorly defined. This study aimed to characterize demographic predictors, treatment patterns, and survival disparities in early-onset pNET (EOPNET) using national data.

Methods: We analyzed the National Cancer Database (2012–2021) for patients with pNET. EOPNET was defined as diagnosis at age < 50. Multivariable logistic regression and Cox models assessed predictors of EOPNET and all-cause mortality among patients with pNET, adjusting for demographics, tumor features, treatment, and socioeconomic factors. Trends in diagnosis and survival by income and urbanicity were examined using chi-square and trend tests.

Results: Among 4,576 pNET cases, 953 (20.8%) were EOPNET, with a median age of 42 (IQR 35–46). The proportion of EOPNET was stable over time. Compared to late onset pNET, EOPNET patients were more likely to be female (49.7% vs. 43.5%), Black (16.9% vs. 10.7%), Hispanic (11% vs. 6.2%), and have private insurance (73.2% vs. 40.9%) or Medicaid (13% vs. 5.8%) (all P < 0.001). They had fewer comorbidities (Charlson-Deyo 0–1: 95% vs. 89.5%, P < 0.0001) and higher rates of surgical resection (82.7% vs. 72.1%, P < 0.001). There were no differences in tumor grade, stage, or receipt of chemotherapy/radiation. In multivariable analysis of patients with pNETs, diagnosis at an early age (EOPNET) was independently associated with improved overall survival (HR 0.56, 95% CI 0.45–0.70). In contrast, Medicaid (HR 1.71, 95% CI 1.32–2.22), Medicare (HR 2.04, 95% CI 1.76–2.37), and uninsured status (HR 1.65, 95% CI 1.10–2.47) — all compared to private insurance — as well as grade III disease (HR 4.01, 95% CI 3.30–4.87), increasing clinical T stage (HR 1.69–2.80 for cT2–cT4 vs. cT1, 95% CI 1.42–3.59), and N stage (HR 1.67–4.22 for cN1–cN2 vs. cN0, 95% CI 1.42–10.35) were significantly associated with worse survival. 10-year overall survival for patients with neuroendocrine EOPC was 81.7% (95% CI 75.9-85.7%) compared to late onset pNET 60.1% (95% CI 57.0%-63.1%), P < 0.001.

Conclusions: EOPNET constitutes a distinct clinical subgroup marked by younger age, greater racial and ethnic diversity, and higher rates of surgical intervention. Despite comparable tumor characteristics, early-onset disease is independently associated with improved survival, highlighting the importance of age-specific approaches to pNET management.

Abstract ID #33486