Low Risk for All-Cause Mortality Among Patients With Lung Neuroendocrine Tumors Co-Diagnosed With Pituitary Adenoma

Abstract

Context: Lung neoplasm often co-occur with pituitary adenoma (PA). However, whether co-diagnosis of lung neuroendocrine tumors (LNET) and PA constitute unique entity, and the impact of such co-diagnosis on patients outcome is yet to be defined. Objective: To compare the clinical characteristics of patients with LNET to those co-diagnosed with PA. Design: Retrospective, case-control study including patients diagnosed with LNET or PA between 2000 and 2016. Setting: The Surveillance, Epidemiology and End Results database. Patients: 2,947 patients had LNET, including 2,913 with LNET alone (“Sporadic”) and 34 patients with both LNET and PA (“MENx”). Main Outcome Measure(s): All-cause mortality (ACM). Results: PA preceded LNET diagnosis in 85.3% of patients and had higher rates among LNET patients (34/2,947) than with any cancer (p<0.00001) and compared to patients with non-small cell lung cancer (NSCLC) (15/2,378, p=0.047). MENx patients were younger at diagnosis compared with NSCLC patients and PA (p=0.04). Among patients<60 years with LNET, co-diagnosis with PA was associated with lower ACM risk (Log-rank test, p=0.03). Adjusted ACM risk of patients with “MENx” was lower than sporadic LNET (hazard ratio 0.553, 95% confidence interval 0.309-0.99, p=0.046), especially among Caucasians, and a lower overall-mortality risk in patients <60 years with borderline statistical significance (p=0.071). Conclusions: Patients with both LNET and PA constitute a distinct morbidity and mortality profile compared with sporadic LNET possibly suggesting an undefined MEN syndrome. Additional studies to further investigate the natural course and genetic profile of patients with these neoplasms are needed.