Emergency and routine presentation of neuroendocrine neoplasia in England: determinants of diagnosis and survival outcomes

Introduction: The mean time from onset of symptoms to diagnosis in NEN is around 5-7 years. Late stage NEN is often diagnosed during an emergency admission. The difference in overall survival (OS) between emergency and elective diagnoses has not been studied. This study assesses factors associated with emergency presentation (EP) versus routine presentation (RP), evaluates factors associated with late presentation, and correlates these with OS.<br/><br/>Methods: A retrospective population-based study using gastroenteropancreatic and lung NEN registered with England’s national cancer database (excluding appendix) between 2012-2021. The Kaplan–Meier estimator was used to predict OS. Cox regression and machine learning (ML) models evaluated factors associated with worse OS. Logistic regression and ML models were used to identify factors associated with emergency and late (disease stage 3 or 4) presentation.<br/><br/>Results: A total of 21,345 NEN were included. 20.3% were EP. EP showed worse OS compared to RP in both models (aHR 1.64, P &lt; 0.001). Factors associated with EP were male sex, advanced disease, increasing deprivation, and carcinoma. Compared to small intestine (SI), caecal, colonic, rectal, pancreatic, lung, and stomach NEN were associated with lower odds of EP. The ML model showed EP associated with advanced stage, SI- NEN, NEC, advancing age, caecal NEN, and colonic NEN in decreasing order of importance. Factors associated with late presentation (LP) included EP, male sex, advancing age, and NEC. Asians were significantly less likely for LP. Compared to SI, caecal NEN were associated with significantly higher odds of LP (OR = 1.69, P &lt; 0.001), while all other NEN had lower odds of LP. The ML model showed NEC, SI- NEN, advanced age, caecal, colonic, and mixed race are associated with LP in decreasing order of importance.<br/><br/>Conclusion: Emergency and late presentation of NEN are associated with poor survival. Addressing causal factors may aid timely diagnosis, decreased emergency presentation and improved survival in NEN.