Higher composite Social Determinants of Health scores predict worsened survival for early-stage small bowel Neuroendocrine Tumors

MD, MSPH Ahmed Alnajar,; MD Frank Yang,; PhD Mehmet Akin,; MD, FACS John I Lew,; MD, FACS Tanaz M Vaghaiwalla,

doi:10.1530/endoabs.116.P3

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Endocrine Abstracts (2025) 116 P3 | DOI: 10.1530/endoabs.116.P3

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

Higher composite Social Determinants of Health scores predict worsened survival for early-stage small bowel Neuroendocrine Tumors

Ahmed Alnajar, MD, MSPH¹, Frank Yang, MD^1,2, Mehmet Akin, PhD¹, John I Lew, MD, FACS^1,2 & Tanaz M Vaghaiwalla, MD, FACS^1,2

Author affiliations

¹DeWitt Daughtry Department of Surgery, University of Miami Health System, Miami, FL University of Miami Leonard M. Miller School of Medicine, Miami, FL; ²Division of Endocrine Surgery; DeWitt Daughtry Department of Surgery, University of Miami Health System, Miami, FL University of Miami Leonard M. Miller School of Medicine, Miami, FL

Background: Patients with early stage well-differentiated small bowel neuroendocrine tumors (sbNETs) typically have favorable overall survival with timely diagnosis and treatment. However, the influence of social determinants of health (SDH) and care at Minority-Serving Hospitals (MSH) on survival in sbNETs patients remain scarce. This study examines the combined impact of SDH factors and hospital type on long-term survival, offering insight into health disparities in patients with early stage sbNETs.

Methods: The 2010-2020 National Cancer Database was queried to include adult patients with G1 and G2 sbNETs, diagnosed with Stage I or II disease who underwent complete surgical resection. Exclusion criteria included G3 NETs, stage III or IV disease, neuroendocrine carcinoma, duodenal NETs, and patients with incomplete follow-up data. The SDH score was developed using a composite of four Sociogeographic factors: (1)low income, (2)low education, (3)distance travelled for treatment (>250 miles), and (4)rurality. Patients were categorized into SDH+ (0-1 score) and SDH- (2-4) cohorts. Hospitals in the top decile of Black and Hispanic patient representation were classified as MSHs. KM curve and Cox regression analyses assessed survival outcome.

Results: Of 2688 sbNET patients, the median age was 64 (54-73) years, with 48% female and 57% classified as SDH-. Overall survival rates at 5, 10, and 15 years were 79%, 62%, and 49%. Stratified by SDH and hospital type, SDH+ patients at MSHs had a 5-year survival of 82%, while SDH- patients dropped to 63%. Non-MSH hospitals showed similar results: 82% for SDH+ and 77% for SDH-. Median survival for SDH- patients was 11 years at MSHs, compared to 12 years at non-MSHs, with minimal SDH impact on survival at non-MSHs (Figure). In the regression analysis, SDH score was a significantly associated with worse survival for the SDH- group (HR 1.24, P < 0.001). Treatment at non-MSH hospitals was linked to significantly better survival (HR 0.41, P < 0.001). Black patients had a 20% higher risk of mortality compared to White patients (HR 1.20, P = 0.002), while there was no significant difference for Hispanic patients(HR 0.87, P = 0.2). Other significant factors included age, sex, and insurance status.

Conclusions: A higher composite SDH score and hospital type were associated with worsened survival for early stage sbNETs. Recognizing SDH factors, such as income, education, and geographic barriers, is crucial in improving cancer outcomes, particularly for populations treated at MSHs. Future studies examining interventions aimed at reducing sociogeographic disparities are needed for patients with sbNETs

Abstract ID #33056