Incidence, prevalence of survival of neuroendocrine neoplasia in England 1995–2018
Benjamin Easton White1,2, Kandiah Chandrakumaran1, Kwok Wong3, Brian Rous4, Catherine Bouvier5, Mieke Van Hemelrijck6, Rajaventhan Srirajaskanthan7 & John K Ramage1,7
Introduction: Incidence of neuroendocrine neoplasia (NEN) is rising worldwide. The National Cancer Registry and Analysis Service allows accurate study of NEN in England.
Aim: Calculate incidence and prevalence of NEN in England from 1995-2018. Calculate site-specific survival with multivariate analysis.
Method: A population-based retrospective cohort study was performed. Data requested from NCRAS were reviewed by a steering group run by Neuroendocrine Cancer UK. Goblet cell carcinoma were excluded. Only 2012–2018 NEN were included in main analysis group due to improved recent coding quality. Eight main primary sites were formed. Merkel and adenoneuroendocrine were excluded. Grade was missing in 31% therefore ‘derived morphology’ groups were formed termed neuroendocrine tumour(NET) and neuroendocrine carcinoma(NEC).
Results: 64,437 NEN were recorded in England between 1995-2018. Age standardized incidence per 100,000 rose steadily from 2.50(95%CI: 2.35–2.65) in 1995 to 8.87(8.61–9.12) in 2018. 5-year prevalence of NEN was 13,439. 19,952 NEN between 2012–2018 met criteria for survival analysis; 51.9% female. Median age 65 years (IQR: 52.0–73.0). Most common sites were lung and small intestine. 76.1% were neuroendocrine tumours(NET) and 23.9% neuroendocrine carcinomas(NEC). Incidence rose in all GEP-NEN sites. Lung NEN plateaued and decreased slightly since 2014. Median follow-up for 19,952 tumours was 2.88 years(IQR: 1.35–4.96). Overall survival was 5.62 years(95%CI: 5.57–5.67). Survival for NEC was 2.62(2.52–2.71) years and NET 6.60(6.55–6.65) years. Site specific survival showed appendix 7.41(7.33–7.48) years, small intestine 5.79(5.69–5.90), rectum 5.782(5.605–5.959), lung 5.188(5.089–5.287), pancreas 5.004(4.871–5.138), stomach 4.697(4.497–4.897), caecum 4.676(4.385–4.966), colon 3.374(3.096–3.652). Black people had survival of 6.59(6.32–6.86) years, Asian people 6.515(6.27–6.75) and White people 5.52(5.47–5.58). The most deprived quintiles had worst survival of all deprivation indices. Sex, ethnicity, deprivation, dwelling(rural/urban), site/stage of tumour and derived morphology were all significant predictors of survival in multivariate analysis.
Conclusion: This analysis of 19,952 NEN in England shows a number of significant factors affecting incidence and survival. More research should be done on these factors.