{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:47:26Z","timestamp":1791305246841,"version":"4.3.1"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Neuroendocrinology"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Given the heterogeneous clinical behavior of pancreatic neuroendocrine tumors (pNETs), improved prognostic markers are needed to guide management and post\u2010resection surveillance. Patients who underwent resection of large (\u22653\u2009cm) sporadic well\u2010differentiated pNETs from 2000 to 2019 were identified. The Ki\u201067 proliferation index was determined using immunohistochemistry, and alternative lengthening of telomeres (ALT) status was assessed using fluorescence in situ hybridization. Recurrence\u2010free and overall survival were estimated using Kaplan\u2013Meier analysis. Multivariable Cox regression analysis evaluated factors associated with recurrence\u2010free survival. A total of 106 patients were identified. ALT was positive in 57 (54%) and negative in 49 (46%). Ki\u201067 was \u22653% in 74 (70%) and &lt;3% in 32 (30%). Tumors with Ki\u201067 \u22653% were more likely to be ALT positive (61% vs. 38%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.046). Stratifying by ALT status and Ki\u201067 proliferation index, median recurrence\u2010free survival was 4.6\u2009years for patients with ALT\u2010positive\/Ki\u201067 \u22653% tumors, 3.1\u2009years for patients with ALT\u2010positive\/Ki\u201067 &lt;3% tumors, 12.4\u2009years for patients with ALT\u2010negative\/Ki\u201067 \u22653% tumors, and 20.2\u2009years for patients with ALT\u2010negative\/Ki\u201067 &lt;3% tumors (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.001). Initial recurrence was distant in 82% and locoregional in 18%. Across all groups, overall survival was similar (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.19). In multivariable analysis, advanced age, ALT positivity, perineural invasion, and lymph node metastases were associated with increased recurrence risk (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.05). ALT and Ki\u201067 provide complementary information on post\u2010resection recurrence risk, which can guide subsequent surveillance and management strategies. These data support the incorporation of ALT testing into routine clinical practice.\n                  <\/jats:p>","DOI":"10.1111\/jne.70003","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T05:53:06Z","timestamp":1739425986000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Alternative lengthening of telomeres and Ki\u201067 proliferation index provide complementary information on recurrence risk after resection of pancreatic neuroendocrine tumors"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-2769","authenticated-orcid":false,"given":"Hallbera","family":"Gudmundsdottir","sequence":"first","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, Department of Surgery Mayo Clinic  Rochester Minnesota USA"},{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rondell P.","family":"Graham","sequence":"additional","affiliation":[{"name":"Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia T.","family":"Greipp","sequence":"additional","affiliation":[{"name":"Medical Genome Facility, Cytogenetics Core Laboratory Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B.","family":"Habermann","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan A.","family":"Knudson","sequence":"additional","affiliation":[{"name":"Medical Genome Facility, Cytogenetics Core Laboratory Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie A.","family":"Brandt","sequence":"additional","affiliation":[{"name":"Medical Genome Facility, Cytogenetics Core Laboratory Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Starlinger","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, Department of Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius A.","family":"Thiels","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, Department of Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne G.","family":"Warner","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, Department of Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory L.","family":"Smoot","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, Department of Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Truty","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, Department of Surgery Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Kendrick","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreas Surgery, 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