Clinical Management and Prognostic Outcomes of Pancreatic Neuroendocrine Tumors: Insights from a Tertiary Care Center

Background and Objectives: Pancreatic neuroendocrine tumors (PanNETs) are rare and heterogeneous neoplasms with variable clinical behavior. Despite advances in diagnosis and treatment, the optimal management strategy remains unclear. This present study aims to evaluate survival outcomes according to first-line therapy and tumor characteristics. Materials and Methods: We conducted a retrospective cohort study including adult patients with histologically confirmed PanNETs who were treated at a tertiary care center between January 2020 and January 2025. Patients were divided into two groups according to their first-line management: surgical resection or non-surgical treatment. Overall survival (OS) was assessed in the entire cohort, and disease-free survival (DFS) was evaluated in patients who underwent complete surgical resection (R0). Results: A total of 68 patients were included, of whom 46 (67.6%) underwent surgery as first-line treatment. In the non-surgical group, 45.5% received combined systemic therapy and somatostatin analogues (SSA), 36.4% received SSA alone, 4.5% systemic therapy alone, and 9.1% were managed with active surveillance. Patients who underwent surgery tended to have lower-grade tumors and earlier-stage disease. The OS rates were 96.5% at one year, 83.2% at three years, and 62.3% at five years, with a median OS of 179 months. Both surgical treatment and lower tumor grade were significantly associated with improved OS. Among patients who had R0 resection, DFS was 95.8% at one year and 84.3% at both three and five years. Lower-grade tumors were also associated with longer DFS. Conclusions: This study demonstrates that first-line surgical resection and lower tumor grade were significantly associated with better OS in patients with PanNETs. Among patients who underwent curative surgery, lower tumor grades were associated with improved DFS.