{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T14:52:14Z","timestamp":1776264734796,"version":"3.50.1"},"reference-count":38,"publisher":"Bioscientifica","issue":"12","content-domain":{"domain":["erc.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11,14]]},"abstract":"<jats:p>\n                    Neuroendocrine neoplasms (NENs) are rare tumors with increasing incidence. Data on the prognosis of NEN patients in the real-world setting are limited. We aim to explore survival predictors and the impact of novel treatments in a cohort of patients with NENs from various primary sites. This was a retrospective study of subjects diagnosed with gastroenteropancreatic (GEP) or thoracic NENs and referred to a single institution over more than a decade (2010\u20132023). The primary objective was to describe the overall survival (OS) and progression-free survival (PFS) of patients with advanced-stage disease undergoing first, second, and third-line therapy. The secondary objectives were to identify predictors of OS and PFS. We included 239 NEN patients. Systemic antineoplastic therapies were administered to 149 subjects (62.3%). In patients treated only with first-line therapy, the OS rate was 75 and 74% at 12 and 18 months, respectively. We observed significant univariable associations between Ki-67 index, primary tumor site, morphology, clinical stage, and OS. The multivariable analysis confirmed a significant association between Ki-67 index, clinical stage, and OS. In patients undergoing second-line therapy, the OS rate was 72 and 61% at 12 and 18 months, respectively, and the Ki-67 index was again associated with OS in the multivariable analysis. GEP NEN patients who received\n                    <jats:sup>177<\/jats:sup>\n                    Lu-Dotatate showed a numerically higher OS rate at 24 months compared to those who did not receive radioligand therapy. In this real-world study of patients with NENs, we confirmed Ki-67 as a strong prognostic parameter and suggested that\n                    <jats:sup>177<\/jats:sup>\n                    Lu-Dotatate has the potential to prolong OS.\n                  <\/jats:p>","DOI":"10.1530\/erc-25-0243","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T13:21:33Z","timestamp":1763126493000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-8","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of survival outcomes in patients with neuroendocrine neoplasms: a real-world retrospective study"],"prefix":"10.1530","volume":"32","author":[{"given":"Marta","family":"Lagan\u00e0","sequence":"first","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Gallo","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maddalena","family":"Salvetti","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Smussi","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Esposito","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Carola","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Carpani","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Morocutti","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Cosentini","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Pedersini","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Grisanti","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfredo","family":"Berruti","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5357-5703","authenticated-orcid":true,"given":"Vito","family":"Amoroso","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Medicine","article-title":"Incidence, survival, and prognostic nomogram of patients with small intestinal neuroendocrine tumors: a SEER population-based study","volume":"103","author":"Peng Y","year":"2024","unstructured":"Peng Y\n, \nXu B\n, \nZhang F\n, et al.\n Incidence, survival, and prognostic nomogram of patients with small intestinal neuroendocrine tumors: a SEER population-based study. Medicine 2024 103 e39616. (https:\/\/doi.org\/10.1097\/MD.0000000000039616)"},{"key":"bib2","series-title":"Virchows Arch","first-page":"341","article-title":"Ki67 labeling index: assessment and prognostic role in gastroenteropancreatic neuroendocrine neoplasms","volume":"472","author":"Kloppel G","year":"2018","unstructured":"Kloppel G\n & \nLa Rosa S\n\n. Ki67 labeling index: assessment and prognostic role in gastroenteropancreatic neuroendocrine neoplasms. Virchows Arch 2018 472 341\u2013349. (https:\/\/doi.org\/10.1007\/s00428-017-2258-0)"},{"key":"bib3","series-title":"Acta Oncol","first-page":"747","article-title":"Malignant ileocaecal serotonin-producing carcinoid tumours: the presence of a solid growth pattern and\/or Ki67 index above 1% identifies patients with a poorer prognosis","volume":"46","author":"Cunningham JL","year":"2007","unstructured":"Cunningham JL\n, \nGrimelius L\n, \nSundin A\n, et al.\n Malignant ileocaecal serotonin-producing carcinoid tumours: the presence of a solid growth pattern and\/or Ki67 index above 1% identifies patients with a poorer prognosis. Acta Oncol 2007 46 747\u2013756. (https:\/\/doi.org\/10.1080\/02841860701218659)"},{"key":"bib4","series-title":"J Clin Oncol","first-page":"2372","article-title":"Metastatic and locally advanced pancreatic endocrine carcinomas: analysis of factors associated with disease progression","volume":"29","author":"Panzuto F","year":"2011","unstructured":"Panzuto F\n, \nBoninsegna L\n, \nFazio N\n, et al.\n Metastatic and locally advanced pancreatic endocrine carcinomas: analysis of factors associated with disease progression. J Clin Oncol 2011 29 2372\u20132377. (https:\/\/doi.org\/10.1200\/JCO.2010.33.0688)"},{"key":"bib5","series-title":"Endocr Relat Cancer","first-page":"1","article-title":"Grading the neuroendocrine tumors of the lung- an evidence-based proposal","volume":"21","author":"Rindi G","year":"2014","unstructured":"Rindi G\n, \nKlersy C\n, \nInzani F\n, et al.\n Grading the neuroendocrine tumors of the lung- an evidence-based proposal. Endocr Relat Cancer 2014 21 1\u201316. (https:\/\/doi.org\/10.1530\/ERC-13-0246)"},{"key":"bib6","series-title":"Ann Oncol","first-page":"152","article-title":"Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): the NORDIC NEC study","volume":"24","author":"Sorbye H","year":"2013","unstructured":"Sorbye H\n, \nWelin S\n, \nLanger SW\n, et al.\n Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): the NORDIC NEC study. Ann Oncol 2013 24 152\u2013160. (https:\/\/doi.org\/10.1093\/annonc\/mds276)"},{"key":"bib7","series-title":"J Clin Oncol","first-page":"3063","article-title":"One hundred years after \u201ccarcinoid\u201d: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States","volume":"26","author":"Yao JC","year":"2008","unstructured":"Yao JC\n, \nHassan M\n, \nPhan A\n, et al.\n One hundred years after \u201ccarcinoid\u201d: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008 26 3063\u20133072. (https:\/\/doi.org\/10.1200\/JCO.2007.15.4377)"},{"key":"bib8","series-title":"Semin Oncol","first-page":"249","article-title":"Epidemiologic trends in neuroendocrine tumors: an examination of incidence rates and survival of specific patient subgroups over the past 20 years","volume":"45","author":"Sackstein PE","year":"2018","unstructured":"Sackstein PE\n, \nO'Neil DS\n, \nNeugut AI\n, et al.\n Epidemiologic trends in neuroendocrine tumors: an examination of incidence rates and survival of specific patient subgroups over the past 20 years. Semin Oncol 2018 45 249\u2013258. (https:\/\/doi.org\/10.1053\/j.seminoncol.2018.07.001)"},{"key":"bib9","series-title":"Lancet","first-page":"2005","article-title":"Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study","volume":"378","author":"Pavel ME","year":"2011","unstructured":"Pavel ME\n, \nHainsworth JD\n, \nBaudin E\n, et al.\n Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study. Lancet 2011 378 2005\u20132012. (https:\/\/doi.org\/10.1016\/S0140-6736(11)61742-X)"},{"key":"bib10","series-title":"Ann Oncol","first-page":"339","article-title":"Sunitinib in pancreatic neuroendocrine tumors: updated progression-free survival and final overall survival from a phase III randomized study","volume":"28","author":"Faivre S","year":"2017","unstructured":"Faivre S\n, \nNiccoli P\n, \nCastellano D\n, et al.\n Sunitinib in pancreatic neuroendocrine tumors: updated progression-free survival and final overall survival from a phase III randomized study. Ann Oncol 2017 28 339\u2013343. (https:\/\/doi.org\/10.1093\/annonc\/mdw561)"},{"key":"bib12","series-title":"Neuroendocrinology","first-page":"85","article-title":"The clinicopathologic heterogeneity of grade 3 gastroenteropancreatic neuroendocrine neoplasms: morphological differentiation and proliferation identify different prognostic categories","volume":"104","author":"Milione M","year":"2017","unstructured":"Milione M\n, \nMaisonneuve P\n, \nSpada F\n, et al.\n The clinicopathologic heterogeneity of grade 3 gastroenteropancreatic neuroendocrine neoplasms: morphological differentiation and proliferation identify different prognostic categories. Neuroendocrinology 2017 104 85\u201393. (https:\/\/doi.org\/10.1159\/000445165)"},{"key":"bib13","series-title":"Eur J Cancer","first-page":"252","article-title":"Long-term survival in patients with gastroenteropancreatic neuroendocrine neoplasms: a population-based study","volume":"172","author":"Polee IN","year":"2022","unstructured":"Polee IN\n, \nHermans BCM\n, \nvan der Zwan JM\n, et al.\n Long-term survival in patients with gastroenteropancreatic neuroendocrine neoplasms: a population-based study. Eur J Cancer 2022 172 252\u2013263. (https:\/\/doi.org\/10.1016\/j.ejca.2022.06.003)"},{"key":"bib14","series-title":"Hum Pathol","first-page":"1124","article-title":"Endocrine tumors of the pancreas: Ki-67 immunoreactivity on paraffin sections is an independent predictor for malignancy: a comparative study with proliferating-cell nuclear antigen and progesterone receptor protein immunostaining, mitotic index, and other clinicopathologic variables","volume":"27","author":"Pelosi G","year":"1996","unstructured":"Pelosi G\n, \nBresaola E\n, \nBogina G\n, et al.\n Endocrine tumors of the pancreas: Ki-67 immunoreactivity on paraffin sections is an independent predictor for malignancy: a comparative study with proliferating-cell nuclear antigen and progesterone receptor protein immunostaining, mitotic index, and other clinicopathologic variables. Hum Pathol 1996 27 1124\u20131134. (https:\/\/doi.org\/10.1016\/s0046-8177(96)90303-2)"},{"key":"bib15","series-title":"JAMA Oncol","first-page":"1335","article-title":"Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States","volume":"3","author":"Dasari A","year":"2017","unstructured":"Dasari A\n, \nShen C\n, \nHalperin D\n, et al.\n Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017 3 1335\u20131342. (https:\/\/doi.org\/10.1001\/jamaoncol.2017.0589)"},{"key":"bib16","series-title":"Hematol Oncol Clin North Am","first-page":"179","article-title":"Peptide receptor radionuclide therapy in the treatment of neuroendocrine tumors","volume":"30","author":"Kwekkeboom DJ","year":"2016","unstructured":"Kwekkeboom DJ\n & \nKrenning EP\n\n. Peptide receptor radionuclide therapy in the treatment of neuroendocrine tumors. Hematol Oncol Clin North Am 2016 30 179\u2013191. (https:\/\/doi.org\/10.1016\/j.hoc.2015.09.009)"},{"key":"bib17","series-title":"N Engl J Med","first-page":"125","article-title":"Phase 3 trial of (177)Lu-Dotatate for midgut neuroendocrine tumors","volume":"376","author":"Strosberg J","year":"2017","unstructured":"Strosberg J\n, \nEl-Haddad G\n, \nWolin E\n, et al.\n Phase 3 trial of (177)Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med 2017 376 125\u2013135. (https:\/\/doi.org\/10.1056\/NEJMoa1607427)"},{"key":"bib18","series-title":"JAMA Netw Open","article-title":"Association of upfront peptide receptor radionuclide therapy with progression-free survival among patients with enteropancreatic neuroendocrine tumors","volume":"5","author":"Pusceddu S","year":"2022","unstructured":"Pusceddu S\n, \nPrinzi N\n, \nTafuto S\n, et al.\n Association of upfront peptide receptor radionuclide therapy with progression-free survival among patients with enteropancreatic neuroendocrine tumors. JAMA Netw Open 2022 5 e220290. (https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.0290)"},{"key":"bib19","series-title":"Ann Oncol","article-title":"887O first multicentric randomized phase II trial investigating the antitumor efficacy of peptide receptor radionucleide therapy with 177Lutetium-Octreotate (OCLU) in unresectable progressive neuroendocrine pancreatic tumor: results of the OCLURANDOM trial","volume":"33","author":"Baudin E","year":"2022","unstructured":"Baudin E\n, \nWalter TA\n, \nBeron A\n, et al.\n 887O first multicentric randomized phase II trial investigating the antitumor efficacy of peptide receptor radionucleide therapy with 177Lutetium-Octreotate (OCLU) in unresectable progressive neuroendocrine pancreatic tumor: results of the OCLURANDOM trial. Ann Oncol 2022 33 S954. (https:\/\/doi.org\/10.1016\/j.annonc.2022.07.1013)"},{"key":"bib20","series-title":"Lancet","first-page":"2807","article-title":"[(177)Lu]Lu-DOTA-TATE plus long-acting octreotide versus high-dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2\u20133, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study","volume":"403","author":"Singh S","year":"2024","unstructured":"Singh S\n, \nHalperin D\n, \nMyrehaug S\n, et al.\n [(177)Lu]Lu-DOTA-TATE plus long-acting octreotide versus high-dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2\u20133, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet 2024 403 2807\u20132817. (https:\/\/doi.org\/10.1016\/S0140-6736(24)00701-3)"},{"key":"bib1","series-title":"Medicine","article-title":"Incidence, survival, and prognostic nomogram of patients with small intestinal neuroendocrine tumors: a SEER population-based study","volume":"103","author":"Peng Y","year":"2024","unstructured":"Peng Y\n, \nXu B\n, \nZhang F\n, et al.\n Incidence, survival, and prognostic nomogram of patients with small intestinal neuroendocrine tumors: a SEER population-based study. Medicine 2024 103 e39616. (https:\/\/doi.org\/10.1097\/MD.0000000000039616)"},{"key":"bib2","series-title":"Virchows Arch","first-page":"341","article-title":"Ki67 labeling index: assessment and prognostic role in gastroenteropancreatic neuroendocrine neoplasms","volume":"472","author":"Kloppel G","year":"2018","unstructured":"Kloppel G\n & \nLa Rosa S\n\n. Ki67 labeling index: assessment and prognostic role in gastroenteropancreatic neuroendocrine neoplasms. Virchows Arch 2018 472 341\u2013349. (https:\/\/doi.org\/10.1007\/s00428-017-2258-0)"},{"key":"bib3","series-title":"Acta Oncol","first-page":"747","article-title":"Malignant ileocaecal serotonin-producing carcinoid tumours: the presence of a solid growth pattern and\/or Ki67 index above 1% identifies patients with a poorer prognosis","volume":"46","author":"Cunningham JL","year":"2007","unstructured":"Cunningham JL\n, \nGrimelius L\n, \nSundin A\n, et al.\n Malignant ileocaecal serotonin-producing carcinoid tumours: the presence of a solid growth pattern and\/or Ki67 index above 1% identifies patients with a poorer prognosis. Acta Oncol 2007 46 747\u2013756. (https:\/\/doi.org\/10.1080\/02841860701218659)"},{"key":"bib4","series-title":"J Clin Oncol","first-page":"2372","article-title":"Metastatic and locally advanced pancreatic endocrine carcinomas: analysis of factors associated with disease progression","volume":"29","author":"Panzuto F","year":"2011","unstructured":"Panzuto F\n, \nBoninsegna L\n, \nFazio N\n, et al.\n Metastatic and locally advanced pancreatic endocrine carcinomas: analysis of factors associated with disease progression. J Clin Oncol 2011 29 2372\u20132377. (https:\/\/doi.org\/10.1200\/JCO.2010.33.0688)"},{"key":"bib5","series-title":"Endocr Relat Cancer","first-page":"1","article-title":"Grading the neuroendocrine tumors of the lung- an evidence-based proposal","volume":"21","author":"Rindi G","year":"2014","unstructured":"Rindi G\n, \nKlersy C\n, \nInzani F\n, et al.\n Grading the neuroendocrine tumors of the lung- an evidence-based proposal. Endocr Relat Cancer 2014 21 1\u201316. (https:\/\/doi.org\/10.1530\/ERC-13-0246)"},{"key":"bib6","series-title":"Ann Oncol","first-page":"152","article-title":"Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): the NORDIC NEC study","volume":"24","author":"Sorbye H","year":"2013","unstructured":"Sorbye H\n, \nWelin S\n, \nLanger SW\n, et al.\n Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): the NORDIC NEC study. Ann Oncol 2013 24 152\u2013160. (https:\/\/doi.org\/10.1093\/annonc\/mds276)"},{"key":"bib7","series-title":"J Clin Oncol","first-page":"3063","article-title":"One hundred years after \u201ccarcinoid\u201d: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States","volume":"26","author":"Yao JC","year":"2008","unstructured":"Yao JC\n, \nHassan M\n, \nPhan A\n, et al.\n One hundred years after \u201ccarcinoid\u201d: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008 26 3063\u20133072. (https:\/\/doi.org\/10.1200\/JCO.2007.15.4377)"},{"key":"bib8","series-title":"Semin Oncol","first-page":"249","article-title":"Epidemiologic trends in neuroendocrine tumors: an examination of incidence rates and survival of specific patient subgroups over the past 20 years","volume":"45","author":"Sackstein PE","year":"2018","unstructured":"Sackstein PE\n, \nO'Neil DS\n, \nNeugut AI\n, et al.\n Epidemiologic trends in neuroendocrine tumors: an examination of incidence rates and survival of specific patient subgroups over the past 20 years. Semin Oncol 2018 45 249\u2013258. (https:\/\/doi.org\/10.1053\/j.seminoncol.2018.07.001)"},{"key":"bib9","series-title":"Lancet","first-page":"2005","article-title":"Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study","volume":"378","author":"Pavel ME","year":"2011","unstructured":"Pavel ME\n, \nHainsworth JD\n, \nBaudin E\n, et al.\n Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study. Lancet 2011 378 2005\u20132012. (https:\/\/doi.org\/10.1016\/S0140-6736(11)61742-X)"},{"key":"bib10","series-title":"Ann Oncol","first-page":"339","article-title":"Sunitinib in pancreatic neuroendocrine tumors: updated progression-free survival and final overall survival from a phase III randomized study","volume":"28","author":"Faivre S","year":"2017","unstructured":"Faivre S\n, \nNiccoli P\n, \nCastellano D\n, et al.\n Sunitinib in pancreatic neuroendocrine tumors: updated progression-free survival and final overall survival from a phase III randomized study. Ann Oncol 2017 28 339\u2013343. (https:\/\/doi.org\/10.1093\/annonc\/mdw561)"},{"key":"bib12","series-title":"Neuroendocrinology","first-page":"85","article-title":"The clinicopathologic heterogeneity of grade 3 gastroenteropancreatic neuroendocrine neoplasms: morphological differentiation and proliferation identify different prognostic categories","volume":"104","author":"Milione M","year":"2017","unstructured":"Milione M\n, \nMaisonneuve P\n, \nSpada F\n, et al.\n The clinicopathologic heterogeneity of grade 3 gastroenteropancreatic neuroendocrine neoplasms: morphological differentiation and proliferation identify different prognostic categories. Neuroendocrinology 2017 104 85\u201393. (https:\/\/doi.org\/10.1159\/000445165)"},{"key":"bib13","series-title":"Eur J Cancer","first-page":"252","article-title":"Long-term survival in patients with gastroenteropancreatic neuroendocrine neoplasms: a population-based study","volume":"172","author":"Polee IN","year":"2022","unstructured":"Polee IN\n, \nHermans BCM\n, \nvan der Zwan JM\n, et al.\n Long-term survival in patients with gastroenteropancreatic neuroendocrine neoplasms: a population-based study. Eur J Cancer 2022 172 252\u2013263. (https:\/\/doi.org\/10.1016\/j.ejca.2022.06.003)"},{"key":"bib14","series-title":"Hum Pathol","first-page":"1124","article-title":"Endocrine tumors of the pancreas: Ki-67 immunoreactivity on paraffin sections is an independent predictor for malignancy: a comparative study with proliferating-cell nuclear antigen and progesterone receptor protein immunostaining, mitotic index, and other clinicopathologic variables","volume":"27","author":"Pelosi G","year":"1996","unstructured":"Pelosi G\n, \nBresaola E\n, \nBogina G\n, et al.\n Endocrine tumors of the pancreas: Ki-67 immunoreactivity on paraffin sections is an independent predictor for malignancy: a comparative study with proliferating-cell nuclear antigen and progesterone receptor protein immunostaining, mitotic index, and other clinicopathologic variables. Hum Pathol 1996 27 1124\u20131134. (https:\/\/doi.org\/10.1016\/s0046-8177(96)90303-2)"},{"key":"bib15","series-title":"JAMA Oncol","first-page":"1335","article-title":"Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States","volume":"3","author":"Dasari A","year":"2017","unstructured":"Dasari A\n, \nShen C\n, \nHalperin D\n, et al.\n Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017 3 1335\u20131342. (https:\/\/doi.org\/10.1001\/jamaoncol.2017.0589)"},{"key":"bib16","series-title":"Hematol Oncol Clin North Am","first-page":"179","article-title":"Peptide receptor radionuclide therapy in the treatment of neuroendocrine tumors","volume":"30","author":"Kwekkeboom DJ","year":"2016","unstructured":"Kwekkeboom DJ\n & \nKrenning EP\n\n. Peptide receptor radionuclide therapy in the treatment of neuroendocrine tumors. Hematol Oncol Clin North Am 2016 30 179\u2013191. (https:\/\/doi.org\/10.1016\/j.hoc.2015.09.009)"},{"key":"bib17","series-title":"N Engl J Med","first-page":"125","article-title":"Phase 3 trial of (177)Lu-Dotatate for midgut neuroendocrine tumors","volume":"376","author":"Strosberg J","year":"2017","unstructured":"Strosberg J\n, \nEl-Haddad G\n, \nWolin E\n, et al.\n Phase 3 trial of (177)Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med 2017 376 125\u2013135. (https:\/\/doi.org\/10.1056\/NEJMoa1607427)"},{"key":"bib18","series-title":"JAMA Netw Open","article-title":"Association of upfront peptide receptor radionuclide therapy with progression-free survival among patients with enteropancreatic neuroendocrine tumors","volume":"5","author":"Pusceddu S","year":"2022","unstructured":"Pusceddu S\n, \nPrinzi N\n, \nTafuto S\n, et al.\n Association of upfront peptide receptor radionuclide therapy with progression-free survival among patients with enteropancreatic neuroendocrine tumors. JAMA Netw Open 2022 5 e220290. (https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.0290)"},{"key":"bib19","series-title":"Ann Oncol","article-title":"887O first multicentric randomized phase II trial investigating the antitumor efficacy of peptide receptor radionucleide therapy with 177Lutetium-Octreotate (OCLU) in unresectable progressive neuroendocrine pancreatic tumor: results of the OCLURANDOM trial","volume":"33","author":"Baudin E","year":"2022","unstructured":"Baudin E\n, \nWalter TA\n, \nBeron A\n, et al.\n 887O first multicentric randomized phase II trial investigating the antitumor efficacy of peptide receptor radionucleide therapy with 177Lutetium-Octreotate (OCLU) in unresectable progressive neuroendocrine pancreatic tumor: results of the OCLURANDOM trial. Ann Oncol 2022 33 S954. 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