Supplementary Material for: Impact of Sex and Deprivation on Neuroendocrine Tumour Survival: Challenges of Heterogeneous Data

Background: For decades, the incidence of neuroendocrine tumours (NETs) has been steadily increasing. Existing research suggests that patient sociodemographic characteristics, such as sex and deprivation, may play a role in who survives a NET diagnosis. This systematic review identifies the available evidence assessing the impact of sex and deprivation on the prognosis of patients diagnosed with NETs.
Methods: Using protocol-driven search terms, Embase and Ovid were searched in July 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The identified studies were critically appraised using the Joanna Briggs Manual for Evidence Synthesis.
Results: The search identified 2041 unique citations of which 66 articles were subsequently included. One study was excluded based on the critical appraisal. Findings were reported by geographical location. Included studies indicate a female survival advantage in North America and England, but the impact of sex on NET prognosis in wider European and Asian countries is less clear. The impact of deprivation on NET prognosis was assessed in North America, with one study conducted in Europe.
Conclusions: Significant data heterogeneity across studies posed challenges for comparability between studies and hindered statistical analyses of these data. In North America and England, females diagnosed with NETs tend to survive longer than males. Existing single-centre studies do not provide conclusive evidence on the impact of sex on NET survival in Asian countries, and . While a greater number of population-based studies within Europe and Asia are needed., Ffuture research should also focus on addressing outcome heterogeneity across NET research to allow for more robust evidence synthesis, providing increased accuracy and generalisability of study results.

背景：数十年来，神经内分泌肿瘤（neuroendocrine tumours, NETs）的发病率持续攀升。现有研究表明，患者的社会人口学特征，如性别与社会剥夺程度，可能对神经内分泌肿瘤确诊患者的生存情况产生影响。本系统综述旨在梳理现有相关证据，评估性别与社会剥夺程度对神经内分泌肿瘤患者预后的影响。
方法：本研究遵循《系统综述与元分析首选报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-analyses, PRISMA）规范，于2024年7月针对Embase与Ovid数据库开展基于预设检索策略的文献检索。采用《乔安娜·布里格斯证据合成手册》（Joanna Briggs Manual for Evidence Synthesis）对纳入的研究进行严格质量评价。
结果：本次检索共获取2041篇独立引用文献，最终纳入66篇相关研究，经质量评价排除1篇。研究结果按地域分组汇报：纳入研究显示，在北美与英格兰地区，女性神经内分泌肿瘤患者的生存优势更为显著；但在更广泛的欧洲与亚洲国家中，性别对神经内分泌肿瘤预后的影响尚不明确。针对社会剥夺程度对神经内分泌肿瘤预后影响的评估仅见于北美地区，欧洲地区仅有1项相关研究。
结论：不同研究间存在显著的数据异质性，这给研究间的可比性带来挑战，同时阻碍了针对此类数据的统计分析。在北美与英格兰地区，确诊神经内分泌肿瘤的女性患者生存期普遍长于男性患者。现有针对亚洲国家的单中心研究尚未能为性别对神经内分泌肿瘤患者生存的影响提供确凿证据；欧洲与亚洲地区亟需开展更多基于人群的研究。未来研究还应聚焦于解决神经内分泌肿瘤研究中的结局异质性问题，以实现更可靠的证据合成，提升研究结果的准确性与外推性。