Symptom burden and outcomes among patients with early-onset versus average-onset neuroendocrine neoplasms

The incidence of neuroendocrine neoplasms (NENs) is rising, particularly among younger patients, but data comparing early-onset (EO-NENs) and average-onset (AO-NENs) remain limited. Using the National Inpatient Sample (2016-2020), we compared patient characteristics, symptom burden, and outcomes between these groups.

Hospitalizations with NENs were identified using ICD-10 codes and stratified as EO (< 50 years) or AO (≥ 50 years). Demographics, comorbidities, symptom burden, interventions, and outcomes were compared using t-tests, chi-squared tests, and logistic regression analysis (p < 0.001 significant because of Bonferroni correction).

We identified 22,555 EO-NEN and 149,470 AO-NEN hospitalizations. EO-NEN patients were more often female (55% vs. 49%). Private insurance was more common in EO-NENs (59% vs. 28%, p < 0.001). EO-NENs were more frequently intestinal or thymic in origin. Symptom burden was higher in EO-NENs, including nausea/vomiting (8.6% vs. 4.7%), constipation (13.9% vs. 10.8%), abdominal pain (1.9% vs. 1.3%), and anxiety (18.3% vs. 14.0%; all p < 0.001). AO-NENs experienced more acute complications (heart failure, cardiac arrest). Multivariate analysis showed no significant difference in odds of inpatient mortality between both cohorts. EO-NEN hospitalizations had higher rates of treatment with chemotherapy (6.1% vs. 4.2%) and surgical resection.

EO-NENs represent a clinically distinct subset with greater symptom burden but fewer acute complications and similar mortality compared to AO-NENs. These findings highlight the need for age-tailored care pathways and further research into the unique biology driving EO-NENs.