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SAGES 2026 Annual Meeting Emerging Technology Session
March 25-28, 2026 | Tampa, FL, USA
P478
ASSOCIATION BETWEEN HOUSEHOLD INCOME AND SURVIVAL AFTER RESECTION OF SMALL BOWEL NEUROENDOCRINE NEOPLASMS: A SEER-BASED ANALYSIS.
Poster Presenter
Part of Topic
Colorectal
Background:
•SB-NENs are a group of mostly indolent malignancies in the Small intestine.1,2 Surgical resection remains the mainstay of treatment for SB–NENs.5 Radical resection for poorly differentiated and local excision for well differentiated.
•SB-NENs are the most common small bowel malignancy, at 37.4% in the United States.3As of 2021, the incidence of SB-NENs in the U.S. was estimated to be 1.4 cases per 100000.4
•We hypothesized that low household income is associated with reduced survival after resection of SB-NENs due to limited access to quality care and treatment resources in the low-income group.
•The present study aimed to assess the association between household income, as an important sociodemographic parameter, and cancer-specific survival (CSS) and overall survival (OS) in patients with surgically resected SB-NENs.
Methods:
Design & Setting
•Retrospective cohort study using the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Database, 2006-2022.
•Four groups, low income (<$50,000), average income ($50,000-$74,999), above average income ($75,000-$119,999), and high income (>$120,000).; categorized according to the median household income in the United States in 2006-20226.
Population & Eligibility
•Included: 11,379 patients with SB-NENs who underwent surgical resection.
•Excluded: other small bowel cancer histological types, unknown disease stages, and patients who did not undergo surgery or did not have a surgery recorded were excluded.
Exposure Groups
•The main exposure was household income, and the main outcome was survival.
Primary & Secondary Outcomes
•Primary: 5-year CSS (from diagnosis to death due to cancer).
•Secondary: 5-year OS (from diagnosis to last contact or death)
Statistical Analysis
•Survival: Kaplan–Meier with log-rank tests; Cox regression for independent predictors of cancer specific survival.
•Statistical significance was defined as p<0.005 with a 95% confidence interval (CI).
Results:
Cohort Description:
•A total of 11,379 patients (6.8% low income, 34.5% average income, 52.6% above-average income, and 6.8% high income)
•51.6% were males with a median age of 63.1 years (SD: 12.67)
•Patient Characteristics: 80.1% were White, 63.1% were Married, 87.3% lived in metropolitan areas.
•Disease Characteristics: 44.4% had stage III disease, 51% of neoplasms were in the Ileum.
•Treatment Characteristics: 81.5% had Radical Resection, 10.6% received systemic therapy.
Primary outcome: Unadjusted mean 5-year CSS rate was significantly lower only in the low-income group with Stage III (91.1%, 91.1%, 94%, 95%, p=0.017).
Secondary Outcome: Unadjusted mean 5-year OS rate was significantly lower in the low-income group across all stages (I-IV) (76.4%, 77.3%, 80.8%, 84.8%, p<0.001).
Multivariable Regression Analysis:
•Household Income was not independently associated with CSS (HR: 1.28; 95% CI: 0.81–2.03, p = 0.298).
•The independent predictors of reduced CSS were older age, divorced, single or widowed status, specific carcinoid and neuroendocrine carcinoma histology, and adjuvant systemic therapy.
•Local tumor excision and time from diagnosis to surgery were associated with an increased CSS.
Subgroup Analysis:
•Of 156 patients in the low-income group with neuroendocrine carcinoma, local excision was used in 54.3% of duodenal neuroendocrine carcinomas in this group.
Conclusion:
Key Findings:
•Low-Income Patients:
•Had lower survival after SB-NEN resection than did high-income patients, however household income was not independently associated with survival.
•Were associated with a 26% lower chance of undergoing radical resection for SB-NENs and having a greater reliance on chemotherapy, 31% higher chance of undergoing local tumor excision.
•More often present with neuroendocrine carcinoma and duodenal cancers.
•Lacked timely access to high-volume centers, which can provide radical resection procedures as they hold a higher risk of perioperative complications, and a longer hospital stay.
•Clinical Significance: These findings suggest that income may influence outcomes indirectly, highlighting the need for targeted interventions to address disparities in clinical and sociodemographic differences.
•Limitations: A retrospective SEER analysis; potential risk of selection bias, lack of data on comorbidities, BMI, specific treatment details, and insurance status.
•Future directions: Prospective cohort studies and clinical trials to quantify disparities in treatment access, and patient-reported quality of life, and assess the cost-effectiveness of targeted interventions
References:
1.Wu L, Fu J, Wan L, et al. Survival outcomes and surgical intervention of small intestinal neuroendocrine tumors: a population based retrospective study. Oncotarget. 2017;8(3):4935-4947. doi:10.18632/oncotarget.13632
2.Shah CP, Mramba LK, Bishnoi R, Unnikrishnan A, Duff JM, Chandana SR. Survival trends of metastatic small intestinal neuroendocrine tumor: a population-based analysis of SEER database. J Gastrointest Oncol. 2019;10(5):869-877. doi:10.21037/jgo.2019.05.02
3.Gonzáles-Yovera JG, Roseboom PJ, Concepción-Zavaleta M, et al. Diagnosis and management of small bowel neuroendocrine tumors: A state-of-the-art. World J Methodol. 2022;12(5):381-391. Published 2022 Sep 20. doi:10.5662/wjm.v12.i5.381
4.Scott AT, Howe JR. Management of Small Bowel Neuroendocrine Tumors. J Oncol Pract. 2018;14(8):471-482. doi:10.1200/JOP.18.00135
5.Howe JR, Cardona K, Fraker DL, et al. The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017;46(6):715-731. doi:10.1097/MPA.0000000000000846
6.Statista. U.S. household income distribution 2006-2023. Statista. https://www.statista.com/statistics/758502/percentage-distribution-of-household-income-in-the-us/. Published September 17, 2024.