S249 Socioeconomic Disparities in Pancreatic Neuroendocrine Tumor Survival: A SEER-Based Retrospective Analysis

Introduction: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms with variable behavior. While often indolent, they can present at advanced stages, especially in underserved populations. Social determinants such as race, income, and geography may influence cancer outcomes, but survival disparities in PNETs remain underexplored. This study evaluates how socioeconomic and demographic factors affect cancer-specific survival using a national database. Methods: Data were extracted from the SEER 2018 database for patients diagnosed with microscopically confirmed malignant PNETs from 2004 to 2018. Cases were identified using ICD-O-3 histology codes (8150–8156, 8240–8246, 8163) and restricted to primary pancreatic tumors. Key variables included race, sex, marital status, income, rural-urban status, tumor size, and treatment delay. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for predictors of survival. Spearman rank correlations were used to assess associations between survival time and continuous or ordinal variables. Statistical significance was defined as P < 0.05. Results: Of 6,482 patients, 47.7% were women, 65.1% were Non-Hispanic White, 15.3% were Hispanic and 12.4% Non-Hispanic Black. Marital status, sex, race, and rurality significantly affected survival. Unmarried patients had a 22% higher risk of death (HR 1.22, CI 1.15–1.30, P < 0.0001), rural patients had a 12% higher risk (HR 1.12, CI 1.03–1.22, P = 0.0066), and Hispanic patients had a 22% higher risk compared to Non-Hispanic White patients (HR 1.22, CI 1.14–1.32, P = 1.28e-08). Women had a 10% lower risk than men (HR 0.90, CI 0.86–0.95, P = 3.9e-06). Income was not an independent predictor. Spearman correlation analysis revealed that tumor size (ρ = –0.19) and treatment delay (ρ = –0.10) were weakly negatively correlated with survival time. Conclusion: This investigation found that survival outcomes in PNETs are significantly altered by marital status, sex, rurality, and race. Tumor size and treatment delay were not significant predictors. While this analysis is limited by the retrospective nature of SEER data and lack of tumor grading, these findings underscore the importance of early identification of at-risk groups. As PNETs are increasingly seen in gastroenterology practice, future research should aim to develop targeted care strategies that address demographic gaps in outcome.