Racial and ethnic disparities in incidence and survival among patients with gastroenteropancreatic neuroendocrine tumors in the United States

The burden of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has increased markedly over the past few decades. However, evolving racial and ethnic disparities in incidence and survival remain inadequately characterized. This study systematically evaluated these disparities across major organ sites using updated data. We identified patients diagnosed with GEP-NETs between 2000 and 2021 from the National Cancer Institute’s SEER Program. Organ-specific age-standardized incidence rates and trends were calculated using SEER-22 data. Survival disparities were assessed using SEER-17 data, with absolute disparities quantified through cumulative mortality and relative disparities analyzed using Cox and Fine–Gray competing-risk regression models. The SEER-22 and SEER-17 datasets included 146,994 and 53,578 cases of GEP-NETs, respectively. Incidence rates were highest for non-Hispanic Black (NHB) individuals in major organ sites, except for the stomach and appendix, where Hispanic and non-Hispanic White (NHW) individuals had higher rates. Incidence trends increased across all sites except the colon, with variation across racial and ethnic groups. The risk of overall mortality was greater among NHB than NHW individuals, particularly in the appendix (HR = 1.45, 95% CI = 1.16 to 1.82). For NET-specific mortality, NHB individuals experienced increased risk in the stomach (subdistribution hazard ratio [sHR] = 1.27, 95% CI = 1.00 to 1.60) and appendix (sHR = 1.54, 95% CI = 1.11 to 2.14), but reduced risk in the small intestine (sHR = 0.84, 95% CI = 0.73 to 0.97). NHB individuals also had a higher risk of cardiovascular disease (CVD) mortality, particularly among patients with pancreatic NETs (sHR = 2.02, 95% CI = 1.38 to 2.97). Racial and ethnic disparities in GEP-NET incidence and survival vary across tumor sites. NHB patients experience a disproportionate burden of disease and elevated competing mortality risks, underscoring the urgent need for targeted interventions to address oncologic and comorbid health gaps.