P1255 - Small Bowel Adenocarcinomas Exhibit Worse Mortality Compared to Neuroendocrine Tumors With Modulation by Clinical, Demographic, and Socioeconomic Factors

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

SC

Shang-Lin Chung, MD

Yale School of Medicine
New Haven, CT

Shang-Lin Chung, MD¹, Fatima Khan, MD¹, Gyanprakash Ketwaroo, MD², Petr Protiva, MD, MPH³
¹Yale School of Medicine, New Haven, CT; ²Yale University School of Medicine, New Haven, CT; ³Yale University School of Medicine and VA Connecticut Healthcare System, New Haven, CT

Introduction: Small bowel adenocarcinomas are uncommon tumors of the gastrointestinal tract and most common tumors are neuroendocrine. There is a lack of data what clinical, histopathological, socioeconomic, and demographic factors impact cancer-specific survival in adenocarcinoma. We aim to investigate factors that are independently associated with cancer-specific survival in appendiceal malignant tumors using large database.

Methods: Using SEER*Stat software, we extracted U.S. survival data from the Surveillance, Epidemiology and End Results Database for small bowel malignant neoplasm from 2000 to 2019 for individuals ≥30 years of age. We compared survival using the Mantel-Haenszel Log-Rank Test. Relative hazard ratios (HRs) for cancer-related death in the 5-year period following diagnosis were estimated with Cox proportional hazard model. The independent effect of cancer histology was assessed and adjusted for relevant clinical, treatment and sociodemographic covariates. Data was analyzed using SAS 9.4 software. The p-value level of significance was set at < 0.05 for a two-sided test.

Results: We identified 7117 adenocarcinomas and 13264 neuroendocrine tumors of the small bowel. From an overall survival standpoint (see Figure 1), small bowel adenocarcinomas have strikingly poorer survival experience compared to neuroendocrine tumors. This survival disparity is modulated by clinical, demographic, and socioeconomic factors (see Table 1). From a clinical standpoint, high grade tumors and more distant metastases have worse survival trends. In addition, tumors that originate from the jejunum have lower mortality compared to those from the ileum. From a demographic standpoint, interestingly, Black patients statistically have lower mortality compared to White patients. Furthermore, older, female, and non-married patients statistically do better. Finally, regarding socioeconomic factors, patients from higher income counties have lower mortality.

Discussion: Our study demonstrated that small bowel adenocarcinomas have markedly worse mortality compared to neuroendocrine tumors. However, this survival disparity is modulated by multiple factors, including socioeconomic, demographic, and clinical factors. Limitations of this study include its retrospective and cross-sectional study design, and the absence of patient comorbidities. Further research into the interplay between the socioeconomic data, cancer survivorship, and comorbidities should be considered.

Figure: Cancer specific survival experience for small bowel tumors by histological type based on SEERS database research. The Kaplan Meier survival estimator curves are shown and colored according to tumor histology (Graph A) and grade (Grade B), survival experience depended on tumor histological type. Adeno = adenocarcinoma, Carci = carcinoid/neuroendocrine

Parameter	HR	95 % Confidence Limit	P
Site (compared to ileum)
Duodenum	0.996	0.897 – 1.107	0.947
Jejunum	0.859	0.758 – 0.974	0.017
Tumor Type (compared to neuroendocrine tumors)
Adenocarcinoma	7.652	6.841 – 8.560	< 0.001
Sex (compared to female)
Male	1.074	1.004 – 1.149	0.037
Race (compared to White)
American Indian/Alaska Native	1.069	0.688 – 1.662	0.7672
Asian or Pacific Islander	0.903	0.793 – 1.028	0.124
Black	0.867	0.790 - 0.951	0.003
Unknown	0.333	0.158 – 0.703	0.004
Ethnicity (compared to Hispanic)
Non-Hispanic	1.127	1.011 – 1.255	0.0308
Age (compared to >= 60 years old)
< 60 years old	0.578	0.534 – 0.626	< 0.001
Spread (compared to Local)
Distant metastases	3.829	3.412 – 4.298	< 0.001
Regional metastases	1.858	1.653 – 2.089	< 0.001
Unknown	2.135	1.827 – 2.494	< 0.001
Grade (compared to Grade I)
Moderately differentiated (Grade II)	1.533	1.358 – 1.777	< 0.001
Poorly differentiated (Grade III)	2.219	1.933 – 2.547	< 0.001
Undifferentiated; anaplastic (Grade IV)	3.696	2.774 – 4.925	< 0.001
Unknown	1.523	1.335 – 1.736	< 0.001
Year of diagnosis (compared to < = 2010)
> 2010	0.897	0.838 – 0.960	0.002
Surgical Status (compared to resection/excision)
Surgical biopsy or Unknown	0.847	0.662 – 1.083	0.1847
No surgery	2.76	2.514 – 3.031	< 0.001
Marital Status (compared to Married)
Divorced	1.178	1.050 – 1.320	0.005
Single/Unmarried	1.152	1.046 – 1.269	0.004
Unknown	0.971	0.828 – 1.139	0.721
Widowed	1.427	1.298 – 1.568	< 0.001
Income (compared to incomes of patients between $55,000 and $75,000)
< $55,000	0.926	0.852 – 1.007	0.072
> $75,000	0.834	0.761 – 0.914	< 0.001

Table: Multivariate Cox regression analysis (P: p-value, HR: Hazard Ratio, 95% HR CL: 95% Hazard Ratio Confidence Limits)

Disclosures:

Shang-Lin Chung indicated no relevant financial relationships.

Fatima Khan indicated no relevant financial relationships.

Gyanprakash Ketwaroo indicated no relevant financial relationships.

Petr Protiva indicated no relevant financial relationships.

Shang-Lin Chung, MD¹, Fatima Khan, MD¹, Gyanprakash Ketwaroo, MD², Petr Protiva, MD, MPH³. P1255 - Small Bowel Adenocarcinomas Exhibit Worse Mortality Compared to Neuroendocrine Tumors With Modulation by Clinical, Demographic, and Socioeconomic Factors, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.