Background Medical centers with varying levels of expertise treat gastroenteropancreatic neuroendocrine tumors (GEP-NETs), which are relatively rare tumors. This study assesses the impact of center volume on GEP-NET treatment outcomes. Methods We used the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare claims data. The data includes patients diagnosed between 1995 and 2010 who had no health maintenance organization (HMO) coverage, participated in Medicare parts A and B, were older than 65 at diagnosis, had tumor differentiation information, and had no secondary cancer. We identified medical centers at which patients received GEP-NET treatment (surgery, chemotherapy, somatostatin analogues, or radiation therapy) using Medicare claims data. Center volume was divided into 3 tiers – low, medium, and high – based on the number of unique GEP-NET patients treated by a medical center over 2 years. We used Kaplan-Meier curves and Cox regression to assess the association between volume and disease-specific survival. Results We identified 899 GEP-NET patients, of whom 37, 45, and 18% received treatment at low, medium volume, and high-volume centers, respectively. Median disease-specific survival for patients at low and medium tiers were 1.4 years and 5.3 years, respectively, but was not reached for patients at high volume centers. Results showed that patients treated at high volume centers had better survival than those treated in low volume centers (HR: 0.63, 95% CI: 0.4–0.9), but showed no difference in outcomes between medium and high-volume centers. Conclusions Our results suggest that for these increasingly common tumors, referral to a tertiary care center may be indicated. Physicians caring for GEP-NET patients should consider early referral to high volume centers.

ObjectivesThe objective of this study was to evaluate racial differences in cancer treatment and survival in gastroenteropancreatic neuroendocrine tumor (GEP-NET) patients.MethodsUsing the Surveillance, Epidemiology, and End Results Registry, we identified patients with GEP-NETs of the stomach, small intestine (SI), colon, rectum, appendix, and pancreas diagnosed between 1973 and 2014. Demographic, cancer, and treatment information were collected and compared using χ2tests. Multivariable logistic and Cox regression were used to determine disparities in receiving treatment and overall survival.ResultsWe identified 19,031 GEP-NET patients: 2839 were non-Hispanic Blacks, 12,832 non-Hispanic Whites, 2098 Hispanics, and 1262 Asians. African Americans and Hispanics with SI and pancreatic NETs were less likely to be treated with surgery (odds ratio, 0.6; 95% confidence interval [CI], 0.46–0.69; odds ratio, 0.71; 95% CI, 0.51–0.99, respectively). African American race was not an independent predictor of survival; there was a strong trend in stomach, SI, and pancreas NETs (hazard ratio [HR], 1.31; 95% CI, 1–1.7; HR, 1.2; 95% CI, 0.99–1.45; HR, 1.22; 95% CI, 1–1.48, respectively).ConclusionsOur study provides evidence of racial disparities in treatment and survival across GEP-NET primary sites and racial groups. Further studies should be performed to improve our understanding of the reason for these disparities.

Background Emerging evidence demonstrates that surveillance of individuals at high-risk (HRIs) of developing pancreatic adenocarcinoma allows for identification and treatment of resectable tumors with improved survival. Population-based data suggest that hyperglycemia may be present up to three years before the development of pancreatic cancer. We investigated whether elevated hemoglobin A1c (HbA1c) is associated with the development of pancreatic cysts in a pancreatic surveillance program. Methods We performed a retrospective study of HRIs who underwent pancreatic surveillance at a single institution between May 2013 and March 2019, according to published criteria. We collected demographic information, clinical data including HbA1c, and imaging results. We compared data using univariable and multivariable analyses. Our primary outcome was the presence of pancreatic cysts on initial surveillance in patients with elevated HbA1c. Results Ninety-eight patients underwent surveillance imaging via EUS or MRCP and seventy-four patients met inclusion criteria. Thirty patients were found to have cysts on initial imaging. Older age (p < 0.01) and HbA1c in the prediabetic range or higher (p = 0.01) were associated with the presence of cysts or solid lesions on univariable analysis. After controlling for confounders, age (aOR 9.08, 95% CI 2.29–36.10), and HbA1c > 5.7% (aOR 5.82, 95% CI 1.50–22.54) remained associated with presence of cysts and solid lesions in HRIs. In patients with cysts or solid lesions there was a strong association between increased age and elevated HbA1c (p < 0.01). Conclusion HRIs with elevated HbA1c were more likely to have pancreatic cysts compared to individuals with lower HbA1c on initial imaging in a pancreatic surveillance program. These findings may help tailor the surveillance protocols for those at increased risk of developing pancreatic adenocarcinoma.

Objectives In this study, we used the institutional pathological and clinical databases from The Mount Sinai Hospital to investigate the impact of mesenteric mass on clinical and staging features in small intestinal neuroendocrine tumors. Methods Demographic, clinical, and staging data were collected. Tumor-node-metastasis stage was assigned according to the American Joint Committee on Cancer eighth edition staging manual. We used a χ2-square test to evaluate the association between mesenteric mass and presenting symptoms, as well as the association between mesenteric mass and tumor characteristics, type of surgical resection, and use of somatostatin analogues. Results Presence of mesenteric mass was strongly associated with highly symptomatic clinical presentation (P < 0.0001). Patients with a mesenteric mass were more likely to have more advanced tumor status (T3 and T4; P = 0.005). The presence of a mesenteric mass was also more strongly associated with metastatic disease (P = 0.002). Patients with a mesenteric mass were more likely to undergo extensive surgical resection (P < 0.0001) and be treated with somatostatin analogues (P < 0.003). Conclusions The data confirm our clinical observations that mesenteric involvement represents more extensive disease and is also associated with more aggressive treatment.

Background: The GH stimulation test (GHST) is the gold standard for the diagnosis of GH deficiency (GHD), yet a significant number of short children fail to be diagnosed as GHD. We have speculated that pituitary volume (PV) could be used in conjunction with results from the GHST to diagnose GHD; however, cutoff values for low PVs need to be further explored. Objective: To define a diagnostic cutoff value of PV for determining GH treatment eligibility for patients (PTs) with short stature. Patients and Methods: The database of GHST results at a Pediatric Endocrinology center was queried for PTs aged 6-18 yrs who underwent a GHST, MRI, and blood work between 1/2018 - 6/2019. PTs with relevant comorbidities were excluded. Clonidine and L-dopa were used to induce GH secretion during the GHST. GHD was defined as a peak GH ≤ 10 ng/mL. MRIs were acquired on a Philips 1.5 or 3.0 T scanner (1mm slices) and PV was calculated using the ellipsoid formula (LxWxH/2). 144 PTs were the subjects of this study. ROC curve analysis was utilized to generate cutoff values. PV was used to predict GHD in prepubertal (age &lt; 11 yrs) and pubertal (age &gt; 11 yrs) children. The value with the greatest Youden index (J) was selected as the definitive cutoff. Results: The mean (MN) and median (MD) ages of PTs were 12.2 ± 2.2 and 12.3, respectively. The MN and MD ages of prepubertal PTs (n=43) were 9.4 ± 1.1 and 9.7, respectively. The MN and MD ages of pubertal PTs (n=103) were 13.4 ± 1.4 and 13.2, respectively. Initially, 10 ng/mL was utilized as the cutoff for GHD. For predicting GHD from PV in prepubertal PTs, sensitivity was 89.47% and specificity was 66.67%. The distance to corner was 0.3488, and the highest J was 0.5641, corresponding to a PV of 240.00 mm3. The Area Under the Curve (AUC) was 0.6581 with a standard error (SE) of 0.2429 (p&gt;0.05). For predicting GHD from PV in pubertal PTs, sensitivity was 72.94% and specificity was 81.25%. The distance to corner was 0.3292, and the highest J was 0.5419, corresponding to a PV of 275.00 mm3. The AUC was 0.7901 with a SE of 0.0687 (p&lt;0.05). Further analysis was done to explore the use of 7 ng/mL as the cutoff for GHD. For predicting GHD from PV in prepubertal PTs, sensitivity was 25.00% and specificity was 90.91%. The distance to corner was 0.7555, and the highest J was 0.1591, corresponding to a PV of 133.66 mm3. The AUC was 0.4989 with a SE of 0.0931 (p&gt;0.05). For predicting GHD from PV in pubertal PTs, sensitivity was 57.89% and specificity was 63.64%. The distance to corner was 0.5563, and the highest J was 0.2153, corresponding to a PV of 240.00 mm3. The AUC was 0.6112 with a SE of 0.0584 (p&lt;0.05). Conclusion: PVs ≤ 275.00 mm3 in pubertal PTs should be considered low; however, cutoffs for prepubertal PVs were not significant in this study. To our knowledge, we present the first study to generate a PV cutoff based on the GHST. Future studies including more PTs and tanner staging will further improve the accuracy of PV cutoffs for GHT eligibility.