Background:Non-functional well-differentiated pancreatic neuroendocrine tumors (WD-PanNETs) are complex, heterogeneous malignancies with variable prognosis. Despite guideline recommendations, disparities in access to specialized care may impact survival. This study examines whether treatment facility type, geographic travel distance, and treatment modalities are associated with survival outcomes in patients diagnosed with WD-PanNETs.Results:Among 20,174 patients with WD-PanNETs, the median age was 62 years (IQR: 52–70), and 54% were men. The majority were treated at non-academic hospitals (76%), with 2.9% traveling >250 miles for care. Patients treated at non-academic hospitals (24%) had 50% lower 15-year survival rates compared to those treated at academic hospitals (58%) and integrated hospitals (56%) (p< 0.001). Patients traveling >250 miles had a 72% 15-year survival rate, compared to 43% for those traveling <12.5 miles (p< 0.001). In the context of facility-type and geographic distance, treatment at non-academic hospitals <250 miles was associated with a 21% higher mortality risk (HR 1.21, 95% CI 1.12–1.31,p< 0.001), and treatment at low-volume hospitals increased mortality risk by 25% (HR 1.25, 95% CI 1.14–1.37,p< 0.001). In contrast, primary tumor resection was associated with a 64% reduction in mortality risk (HR 0.36, 95% CI 0.33–0.38,p< 0.001), which remained significant at all disease stages.Conclusion:Treatment at academic or high-volume centers and longer travel distances were associated with improved OS in patients with WD-PanNETs. Primary tumor resection remains critical, while systemic therapies were primarily used in later-stage disease. These findings support policies that improve access to centralized, multidisciplinary care.
背景：无功能性高分化胰腺神经内分泌肿瘤（WD-PanNETs）是一种复杂、异质性的恶性肿瘤，其预后存在较大差异。尽管已有相关指南建议，但获得专科诊疗的机会不均可能影响患者生存。本研究探讨了治疗机构类型、地理出行距离及治疗方式是否与WD-PanNETs患者的生存结局相关。 结果：在20,174例WD-PanNETs患者中，中位年龄为62岁（四分位距：52-70岁），男性占54%。大多数患者（76%）在非学术医院接受治疗，其中2.9%的患者就医出行距离超过250英里。在非学术医院接受治疗的患者15年生存率（24%）较学术医院（58%）和综合性医院（56%）患者低50%（p<0.001）。就医出行距离超过250英里的患者15年生存率为72%，而出行距离小于12.5英里的患者仅为43%（p<0.001）。在控制机构类型和地理距离因素后，在250英里内的非学术医院治疗与死亡风险增加21%相关（HR 1.21，95% CI 1.12-1.31，p<0.001），在低手术量医院治疗使死亡风险增加25%（HR 1.25，95% CI 1.14-1.37，p<0.001）。相比之下，原发肿瘤切除术可使死亡风险降低64%（HR 0.36，95% CI 0.33-0.38，p<0.001），且该效应在所有疾病分期中均保持显著。 结论：在学术中心或高手术量中心接受治疗以及更长的就医出行距离与WD-PanNETs患者总生存期的改善相关。原发肿瘤切除术仍是关键治疗手段，而全身性治疗主要应用于晚期疾病。这些发现为改善患者获得集中化、多学科诊疗的可及性提供了政策依据。
肿瘤(癌症)患者之家