Impact of non-metropolitan residence on survival for gastric neuroendocrine tumors.
Publication Title
American journal of surgery
Document Type
Article
Publication Date
1-1-2026
Keywords
Humans; Stomach Neoplasms; Male; Female; Neuroendocrine Tumors; Middle Aged; Aged; United States; Adult; Survival Rate; Retrospective Studies; Neoplasm Staging; Residence Characteristics; Databases, Factual; california; santa monica; sjci
Abstract
BACKGROUND: Gastric neuroendocrine tumors (NETs) treated at academic centers are associated with improved survival. However, the impact of location of residence remains unclear. Here, we evaluated outcomes based on metropolitan or non-metropolitan residence.
METHODS: The National Cancer Database (NCDB) was accessed to identify adult patients diagnosed with invasive gastric NETs from 2004 to 2019.
RESULTS: Of 14665 gastric NETs patients, 13 % (n = 1933) were from non-metropolitan areas. On multivariable analysis, non-metropolitan residence was associated with reduced survival (HR 1.13, p = 0.007). Patients in non-metropolitan areas had a decreased OS with earlier clinical stages 1-2 (HR 1.40, p = 0.011), with higher grades 3-4 tumors (HR 1.26, p = 0.008), or when undergoing surgical resection (HR 1.19, p = 0.01); survival was equivalent for later stage 3-4 tumors and earlier grades 1-2 tumors.
CONCLUSIONS: Non-metropolitan residence conferred an independent survival disadvantage for all gastric NET patients, especially in early stage or high grade tumors and upon surgical resection. Future research should explore causative factors and possible interventions.
Area of Special Interest
Digestive Health
Area of Special Interest
Cancer
Specialty/Research Institute
Gastroenterology
Specialty/Research Institute
Oncology
DOI
10.1016/j.amjsurg.2025.116709
