{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T16:04:54Z","timestamp":1781021094534,"version":"3.54.1"},"reference-count":34,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Appendiceal neuroendocrine tumors (NETs) rank as the third most frequent neoplasm affecting the appendix, originating from enterochromaffin cells. This study aims to evaluate the influence of various prognostic factors on the mortality rates of patients diagnosed with NETs of the appendix. Methods: Conducted retrospectively, the study involved 3346 patients, utilizing data sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis centered on investigating demographic characteristics, clinical features, overall mortality (OM), and cancer-specific mortality (CSM) among the cohort. Variables showing a p-value &lt; 0.1 in the univariate Cox regression were incorporated into the multivariate Cox regression analysis. A Hazard Ratio (HR) &gt; 1 indicated an unfavorable prognosis. Results: In the multivariate analysis, higher OM and CSM were observed in males, older age groups, tumors with distant metastasis, poorly differentiated tumors, and those who underwent chemotherapy. Non-Hispanic Black individuals showed elevated mortality rates. Conclusion: Delayed diagnosis may contribute to the increased mortality in this community. Improved access to healthcare and treatment is crucial for addressing these disparities. Larger prospective studies are needed to pinpoint the underlying causes of elevated mortality in non-Hispanic Black populations, and randomized controlled trials (RCTs) are warranted to evaluate therapies for advanced-stage appendix NETs.<\/jats:p>","DOI":"10.3390\/diseases12050096","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T13:20:24Z","timestamp":1715174424000},"page":"96","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Factors Affecting Survival Outcomes in Neuroendocrine Tumor of the Appendix over the Past Two Decades"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6794-6461","authenticated-orcid":false,"given":"Vignesh Krishnan","family":"Nagesh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izage Kianifar","family":"Aguilar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Elias","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlene","family":"Mansour","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadrian Hoang-Vu","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchi","family":"Bhuju","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanni","family":"Sethi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paranjyothy Rao Pirangi","family":"Sanjeeva","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Gonzalez","family":"Rivas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emelyn","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6422-3961","authenticated-orcid":false,"given":"Auda","family":"Auda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazir","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Philip","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simcha","family":"Weissman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Sotiriadis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayrton","family":"Bangolo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1055\/s-0041-1724064","article-title":"Appendiceal Neuroendocrine Tumours\u2014Experience of One Service","volume":"41","author":"Devezas","year":"2021","journal-title":"J. Coloproctol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Mohamed, A., Wu, S., Hamid, M., Mahipal, A., Cjakrabarti, S., Bajor, D., Selfridge, J.E., and Asa, S.L. (2022). Management of appendix neuroendocrine neoplasms: Insights on the current guidelines. Cancers, 15.","DOI":"10.3390\/cancers15010295"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/SLA.0000000000002736","article-title":"Current management and predictive factors of lymph node metastasis of appendix neuroendocrine tumors: A national study from the French Group of Endocrine Tumors (GTE)","volume":"270","author":"Cao","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Rui Pedro Neto da Silva Abreu (2018). Appendiceal neuroendocrine tumors: Approach and treatment. J. Coloproctol., 38, 337\u2013342.","DOI":"10.1016\/j.jcol.2018.05.010"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4030527","DOI":"10.1155\/2020\/4030527","article-title":"Appendix neuroendocrine tumor: Retrospective analysis of 4026 appendectomy patients in a single center","volume":"2020","author":"Bayhan","year":"2020","journal-title":"Emerg. Med. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1002\/jso.23205","article-title":"Varying malignant potential of appendiceal neuroendocrine tumors: Importance of histologic subtype","volume":"107","author":"Hsu","year":"2013","journal-title":"J. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"19","DOI":"10.32074\/1591-951X-230","article-title":"Neuroendocrine neoplasms of the appendix, colon and rectum","volume":"113","author":"Volante","year":"2021","journal-title":"Pathologica"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.3748\/wjg.v28.i13.1304","article-title":"Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy","volume":"28","author":"Hernando","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"IJE17","DOI":"10.2217\/ije-2019-0001","article-title":"The role of 5-hydroxyindoleacetic acid in neuroendocrine tumors: The journey so far","volume":"6","author":"Nair","year":"2019","journal-title":"Int. J. Endocr. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"99541","DOI":"10.18632\/oncotarget.20362","article-title":"Regional lymph node involvement and outcomes in appendiceal neuroendocrine tumors: A SEER database analysis","volume":"8","author":"Sarshekeh","year":"2017","journal-title":"Oncotarget"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1007\/s12020-019-01984-z","article-title":"Histopathological diagnosis of appendiceal neuroendocrine neoplasms: When to perform a right hemicolectomy? A systematic review and meta-analysis","volume":"66","author":"Ricci","year":"2019","journal-title":"Endocrine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1007\/s11864-023-01093-0","article-title":"An update on appendiceal neuroendocrine tumors","volume":"24","author":"Andrini","year":"2023","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1159\/000499381","article-title":"Challenging the current risk factors of appendiceal neuroendocrine neoplasms: Can they accurately predict local lymph nodal invasion? Results from a large case series","volume":"109","author":"Galanopoulos","year":"2019","journal-title":"Neuroendocrinology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1309\/199VD990LVHPTQUM","article-title":"Does mesoappendix infiltration predict a worse prognosis in incidental neuroendocrine tumors of the appendix? A clinicopathologic and immunohistochemical study of 15 cases","volume":"120","author":"Rossi","year":"2003","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.suronc.2020.08.015","article-title":"Gastro-entero-pancreatic neuroendocrine neoplasia: The rules for non-operative management","volume":"35","author":"Panzuto","year":"2020","journal-title":"Surg. Oncol."},{"key":"ref_16","first-page":"130","article-title":"Currently available treatment options for neuroendocrine liver metastases","volume":"34","author":"Machairas","year":"2021","journal-title":"Ann. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1055\/s-0040-1720951","article-title":"Liver-directed therapy for neuroendocrine tumor liver metastases in the era of peptide receptor radionuclide therapy","volume":"37","author":"Lehrman","year":"2020","journal-title":"Semin. Interv. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1007\/s12029-021-00709-8","article-title":"Management and Survival Analysis of Gastrointestinal Neuroendocrine Tumors by Different Tumor Characteristics: Tertiary Center Experience","volume":"53","author":"Gonulal","year":"2021","journal-title":"J. Gastrointest. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1056\/NEJMoa1607427","article-title":"Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors","volume":"376","author":"Strosberg","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_20","first-page":"CD013700","article-title":"Treatment for gastrointestinal and pancreatic neuroendocrine tumours: A network meta-analysis","volume":"2021","author":"Spanjol","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9032753","DOI":"10.1155\/2019\/9032753","article-title":"CAPTEM in metastatic well-differentiated intermediate to high grade neuroendocrine tumors: A single centre experience","volume":"2019","author":"Sahu","year":"2019","journal-title":"J. Oncol."},{"key":"ref_22","first-page":"817","article-title":"Natural history of gastro-entero-pancreatic and thoracic neuroendocrine tumors. Data from a large prospective and retrospective Italian epidemiological study: The NET management study","volume":"35","author":"Faggiano","year":"2012","journal-title":"J. Endocrinol. Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/SLA.0b013e31815b9cae","article-title":"Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors: Analysis of 3851 patients","volume":"247","author":"Bilimoria","year":"2008","journal-title":"Ann. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"337","DOI":"10.20452\/pamw.2832","article-title":"Gastroenteropancreatic neuroendocrine neoplasms: A 10-year experience of a single center","volume":"125","author":"Lewkowicz","year":"2015","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1093\/annonc\/mdq022","article-title":"Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): Results from the National Cancer Registry of Spain (RGETNE)","volume":"21","author":"Capdevila","year":"2010","journal-title":"Ann. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1097\/MPA.0000000000001431","article-title":"Racial differences in the incidence and survival of patients with neuroendocrine tumors","volume":"48","author":"Shen","year":"2019","journal-title":"Pancreas"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Goksu, S.Y., Ozer, M., Beg, M.S., Sanford, N.N., Ahn, C., Fangman, B.D., Goksu, B.B., Verma, U., Sanjeevaiah, A., and Hsiehchen, D. (2020). Racial\/ethnic disparities and survival characteristics in non-pancreatic gastrointestinal tract neuroendocrine tumors. Cancers, 12.","DOI":"10.3390\/cancers12102990"},{"key":"ref_28","first-page":"583","article-title":"Treatment of metastatic carcinoid tumor with dactinomycin or dacarbazine","volume":"67","author":"Rubin","year":"1983","journal-title":"Cancer Treat. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1097\/00000421-199806000-00005","article-title":"Dacarbazine, fluorouracil, and leucovorin in patients with advanced neuroendocrine tumors: A phase II trial","volume":"21","author":"Ollivier","year":"1998","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"562505","DOI":"10.3389\/fendo.2020.562505","article-title":"mTOR pathway in gastroenteropancreatic neuroendocrine tumor (GEP-NETs)","volume":"11","author":"Zanini","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1159\/000444087","article-title":"Oxaliplatin-based chemotherapy in advanced neuroendocrine tumors: Clinical outcomes and preliminary correlation with biological factors","volume":"103","author":"Spada","year":"2016","journal-title":"Neuroendocrinology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1056\/NEJM198712313172704","article-title":"Carcinoid tumor of the appendix: Treatment and prognosis","volume":"317","author":"Moertel","year":"1987","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.2967\/jnumed.116.180984","article-title":"Localization of unknown primary site with 68Ga-DOTATOC PET\/CT in patients with metastatic neuroendocrine tumor","volume":"58","author":"Menda","year":"2017","journal-title":"J. Nucl. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3063","DOI":"10.1200\/JCO.2007.15.4377","article-title":"One hundred years after \u201ccarcinoid\u201d: Epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States","volume":"26","author":"Yao","year":"2008","journal-title":"J. Clin. Oncol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/5\/96\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:41:51Z","timestamp":1760107311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/5\/96"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,8]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["diseases12050096"],"URL":"https:\/\/doi.org\/10.3390\/diseases12050096","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,8]]}}}