Treatment at Academic Facilities is Associated With Improved Survival in Late-Stage Colonic Neuroendocrine Tumors

Abstract

Introduction

Colonic neuroendocrine tumors (NETs) are a rare disease entity requiring complex and multidisciplinary management, and the survival benefit of treatment facility type has not been determined.

Materials and methods

The National Cancer Database was queried from 2004 to 2021 to identify treatment trends and overall survival (OS) outcomes in patients with stages I-IV colonic NETs who underwent surgery at academic or non-academic facilities.

Results

21,838 patients met the inclusion criteria; 71% were treated at non-academic facilities and 29% at academic facilities. Patients at academic facilities were significantly more likely to be younger (odds ratio [OR] 1.16), reside in a metropolitan area (OR 2.37), and travel farther for care (OR 7.35). Academic facilities were more likely to perform complex en bloc resection (OR 1.15) with more extensive lymphadenectomy (OR 1.42). Treatment at academic facilities was associated with a decreased risk of mortality (hazard ratio [HR] 0.89) on adjusted Cox models. Older age (HR 2.14), increased comorbidities (HR 2.22), uninsured status (HR 1.36), low socioeconomic status (HR 1.08), complex en bloc resection (HR 1.12), and increased nodal positivity (HR 2.42) significantly predicted increased mortality of the entire cohort; subgroup analysis found that low socioeconomic status and uninsured status were not significant predictors of survival at academic facilities. Kaplan–Meier analysis identified a benefit in median OS for those treated at an academic versus non-academic facility (161.1 versus 146.6 mo, P = 0.002). On subgroup Cox analyses by individual clinical stage, treatment at academic facilities was associated with a significantly decreased risk of mortality for patients with late-stage disease (stage III: HR 0.83, P = 0.005; stage IV: HR 0.84, P < 0.001); there was no significant difference in survival by treating facility type for early-stage disease (stage I: HR 1.05, P = 0.58; stage II: HR 0.87, P = 0.12).

Conclusions

Treatment at academic facilities is associated with a survival benefit for patients undergoing surgical resection for late-stage colonic NETs. Further research is needed to understand these survival differences to bridge the gap in care for patients with colonic NETs.