{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:06:27Z","timestamp":1779883587236,"version":"3.53.1"},"reference-count":59,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with increasing incidence, particularly within the gastroenteropancreatic (GEP) system. The liver represents the most common site of metastasis, and neuroendocrine liver metastases (NELMs) significantly impact prognosis, symptom burden, and therapeutic decision-making. Surgical management remains a cornerstone in the treatment of NELMs and encompasses a spectrum of strategies, including curative liver resection, cytoreductive surgery, and, in selected cases, liver transplantation (LT). Hepatic resection, although potentially curative when technically feasible, is applicable only to a highly selected subset of patients, and its benefits in terms of long-term survival and symptom control remain limited by recurrence rates and patient-related factors. Cytoreductive surgery has emerged as a valuable alternative in patients with unresectable disease, with increasing evidence supporting a \u226570% debulking threshold as sufficient to achieve meaningful clinical benefit. This approach may improve survival and quality of life, notably in symptomatic patients, and can be combined with parenchymal-sparing techniques and locoregional therapies. Liver transplantation represents a radical but potentially curative strategy for highly selected patients with liver-only disease, favorable tumor biology, and stable disease. Outcomes are strongly dependent on strict selection criteria, and appropriate patient selection remains critical. The incorporation of systemic treatments, such as somatostatin analogues, targeted therapies, and peptide receptor radionuclide therapy (PRRT), has broadened the available therapeutic options and contributed to redefining current treatment strategies. Overall, the management of NELMs requires a multidisciplinary, individualized approach guided by tumor biology, disease distribution, and patient-specific factors, with the goal of optimizing survival outcomes and preserving quality of life.<\/jats:p>","DOI":"10.3390\/cancers18111745","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:03:27Z","timestamp":1779879807000},"page":"1745","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Approach to Liver Metastasis from Gastroenteropancreatic Neuroendocrine Tumors in the Era of Precision Oncology"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2466-0524","authenticated-orcid":false,"given":"Jorgelina","family":"Coppa","sequence":"first","affiliation":[{"name":"Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Oldani","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pusceddu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0369-301X","authenticated-orcid":false,"given":"Monica","family":"Paoletti","sequence":"additional","affiliation":[{"name":"Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bongini","sequence":"additional","affiliation":[{"name":"Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7745-7573","authenticated-orcid":false,"given":"Federica","family":"Cavalcoli","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Cascella","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6680-623X","authenticated-orcid":false,"given":"Rodolfo","family":"Lanocita","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Sabella","sequence":"additional","affiliation":[{"name":"First Pathology Unit, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Milione","sequence":"additional","affiliation":[{"name":"First Pathology Unit, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0928-2927","authenticated-orcid":false,"given":"Giovanni","family":"Argiroffi","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1389-3250","authenticated-orcid":false,"given":"Marco","family":"Maccauro","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Mazzaferro","sequence":"additional","affiliation":[{"name":"Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, ENETS Center of Excellence, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1001\/jamaoncol.2017.0589","article-title":"Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States","volume":"3","author":"Dasari","year":"2017","journal-title":"JAMA Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e13423","DOI":"10.1111\/jne.13423","article-title":"ENETS 2024 guidance paper for the management of well-differentiated small intestine neuroendocrine tumours","volume":"36","author":"Lamarca","year":"2024","journal-title":"J. Neuroendocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1001\/jamaoncol.2024.5937","article-title":"Gastroenteropancreatic neuroendocrine tumor incidence by sex and age in the US","volume":"11","author":"Abboud","year":"2025","journal-title":"JAMA Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3063","DOI":"10.1200\/JCO.2007.15.4377","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","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kraft, A., Croitoru, A., Moldovan, C., Lupescu, I., Tomescu, D., Purnichescu-Purtan, R., Herlea, V., Popescu, I., and Botea, F. (2021). Is long-term survival in metastases from neuroendocrine neoplasms improved by liver resection?. 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Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1016\/S1470-2045(13)70362-0","article-title":"Recommendations for management of patients with neuroendocrine liver metastases","volume":"15","author":"Frilling","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.hoc.2024.08.001","article-title":"Surgical management of neuroendocrine tumor liver metastases","volume":"39","author":"Tran","year":"2025","journal-title":"Hematol.\/Oncol. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3129","DOI":"10.1245\/s10434-010-1154-5","article-title":"Surgical management of hepatic neuroendocrine tumor metastasis: Results from an international multi-institutional analysis","volume":"17","author":"Mayo","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/SLA.0b013e3181bdf8cf","article-title":"Hepatic metastases from neuroendocrine tumors with a \u201cthin slice\u201d pathological examination: They are many more than you think","volume":"251","author":"Elias","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1245\/s10434-017-5839-x","article-title":"Management of neuroendocrine tumor liver metastases: Long-term outcomes and prognostic factors from a large prospective database","volume":"24","author":"Fairweather","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ka\u00e7maz, E., Heidsma, C.M., Besselink, M.G.H., Dreijerink, K.M.A., Kl\u00fcmpen, H.J., Nieveen van Dijkum, E.J.M., and Engelsman, A.F. (2019). Treatment of liver metastases from midgut neuroendocrine tumours: A systematic review and meta-analysis. J. Clin. Med., 8.","DOI":"10.3390\/jcm8030403"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4840","DOI":"10.1245\/s10434-023-13372-z","article-title":"Survival and symptomatic relief after cytoreductive hepatectomy for neuroendocrine tumor liver metastases: Long-term follow-up evaluation of more than 500 patients","volume":"30","author":"Gudmundsdottir","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e131","DOI":"10.1016\/j.suronc.2012.05.001","article-title":"Surgical resection of hepatic metastases from neuroendocrine neoplasms: A systematic review","volume":"21","author":"Saxena","year":"2012","journal-title":"Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.surg.2015.05.040","article-title":"Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy?","volume":"159","author":"Maxwell","year":"2016","journal-title":"Surgery"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.surg.2018.04.070","article-title":"Effective cytoreduction can be achieved in patients with numerous neuroendocrine tumor liver metastases (NETLMs)","volume":"165","author":"Scott","year":"2019","journal-title":"Surgery"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1007\/s11605-017-3490-2","article-title":"Early recurrence of neuroendocrine liver metastasis after curative hepatectomy: Risk factors, prognosis, and treatment","volume":"21","author":"Zhang","year":"2017","journal-title":"J. Gastrointest. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1016\/j.ejso.2017.04.010","article-title":"Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas","volume":"43","author":"Galleberg","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/bjs.6468","article-title":"Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease","volume":"96","author":"Frilling","year":"2009","journal-title":"Br. J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.hpb.2019.08.011","article-title":"ALPPS in neuroendocrine liver metastases not amenable for conventional resection\u2014Lessons learned from an interim analysis of the International ALPPS Registry","volume":"22","author":"Linecker","year":"2020","journal-title":"HPB"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/SLA.0000000000006365","article-title":"Recommendations on robotic hepato-pancreato-biliary surgery: The Paris Jury-Based Consensus Conference","volume":"281","author":"Hobeika","year":"2025","journal-title":"Ann. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/j.surg.2012.08.027","article-title":"Outcomes of laparoscopic and open resection for neuroendocrine liver metastases","volume":"152","author":"Kandil","year":"2012","journal-title":"Surgery"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.14701\/ahbps.21-101","article-title":"Impact of the extent of resection of neuroendocrine tumor liver metastases on survival: A systematic review and meta-analysis","volume":"26","author":"Kulkarni","year":"2022","journal-title":"Ann. Hepatobiliary Pancreat. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1111\/j.1477-2574.2010.00198.x","article-title":"Long-term survival after surgical management of neuroendocrine hepatic metastases","volume":"12","author":"Glazer","year":"2010","journal-title":"HPB"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1016\/j.surg.2014.08.009","article-title":"Expanded criteria for carcinoid liver debulking: Maintaining survival and increasing the number of eligible patients","volume":"156","author":"Sauer","year":"2014","journal-title":"Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/MPA.0000000000000846","article-title":"The surgical management of small bowel neuroendocrine tumors: Consensus guidelines of the North American Neuroendocrine Tumor Society","volume":"46","author":"Howe","year":"2017","journal-title":"Pancreas"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.surg.2008.06.008","article-title":"The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors","volume":"144","author":"Chambers","year":"2008","journal-title":"Surgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.surg.2017.05.030","article-title":"Expanded criteria for debulking of liver metastasis also apply to pancreatic neuroendocrine tumors","volume":"163","author":"Morgan","year":"2018","journal-title":"Surgery"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.jhep.2023.03.029","article-title":"Transplantation for metastatic liver disease","volume":"78","author":"Clift","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1097\/SLA.0b013e31828ee17c","article-title":"Liver transplantation for neuroendocrine tumors in Europe\u2014Results and trends in patient selection: A 213-case European liver transplant registry study","volume":"257","author":"Klempnauer","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.surg.2017.05.006","article-title":"Liver transplantation in patients with liver metastases from neuroendocrine tumors: A systematic review","volume":"162","author":"Moris","year":"2017","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1111\/tri.13358","article-title":"2018 annual report of the European Liver Transplant Registry (ELTR)\u201450-year evolution of liver transplantation","volume":"31","author":"Adam","year":"2018","journal-title":"Transpl. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.jhep.2007.07.004","article-title":"Neuroendocrine tumors metastatic to the liver: How to select patients for liver transplantation?","volume":"47","author":"Mazzaferro","year":"2007","journal-title":"J. Hepatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1111\/j.1600-6143.2008.02233.x","article-title":"Predictors of long-term survival after liver transplantation for metastatic endocrine tumors: An 85-case French multicentric report","volume":"8","author":"Belghiti","year":"2008","journal-title":"Am. J. Transplant."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2892","DOI":"10.1111\/ajt.13831","article-title":"The long-term benefit of liver transplantation for hepatic metastases from neuroendocrine tumors","volume":"16","author":"Mazzaferro","year":"2016","journal-title":"Am. J. Transplant."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1001\/archsurg.2011.186","article-title":"Liver transplantation for the treatment of liver metastases from neuroendocrine tumors: An analysis of the UNOS database","volume":"146","author":"Gedaly","year":"2011","journal-title":"Arch. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1097\/01.sla.0000161981.58631.ab","article-title":"Neuroendocrine hepatic metastases: Does aggressive management improve survival?","volume":"241","author":"Touzios","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_39","unstructured":"Organ Procurement and Transplantation Network (2023, January 12). Guidance to Liver Transplant Programs and the National Liver Review Board for: Adult MELD Exception Review, Available online: https:\/\/optn.transplant.hrsa.gov\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1159\/000443167","article-title":"ENETS Consensus Guidelines update for the management of distant metastatic disease of intestinal, pancreatic, bronchial neuroendocrine neoplasms and neuroendocrine neoplasms of unknown primary site","volume":"103","author":"Pavel","year":"2016","journal-title":"Neuroendocrinology"},{"key":"ref_41","unstructured":"North American Neuroendocrine Tumor Society (2022). NANETS Guidelines Compendium, North American Neuroendocrine Tumor Society. Available online: https:\/\/nanets.net\/."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1111\/ajt.17156","article-title":"Long-term outcomes of resection versus transplantation for neuroendocrine liver metastases meeting the Milan criteria","volume":"22","author":"Maspero","year":"2022","journal-title":"Am. J. Transplant."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e1063","DOI":"10.1097\/SLA.0000000000005663","article-title":"Controversy over liver transplantation or resection for neuroendocrine liver metastasis: Tumor biology cuts the deal","volume":"277","author":"Eshmuminov","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1200\/JCO.22.01013","article-title":"Randomized Study of Temozolomide or Temozolomide and Capecitabine in Patients with Advanced Pancreatic Neuroendocrine Tumors (ECOG-ACRIN E2211)","volume":"41","author":"Kunz","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1056\/NEJMoa1607427","article-title":"Phase 3 trial of 177Lu-dotatate for midgut neuroendocrine tumors","volume":"376","author":"Strosberg","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_46","first-page":"e13465","article-title":"Current status of peptide receptor radionuclide therapy in grade 1 and 2 gastroenteropancreatic neuroendocrine tumours","volume":"36","author":"Kuiper","year":"2024","journal-title":"J. Neuroendocrinol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"940","DOI":"10.7150\/thno.91268","article-title":"Peptide receptor radionuclide therapy combinations for neuroendocrine tumours in ongoing clinical trials: Status 2023","volume":"14","author":"Santo","year":"2024","journal-title":"Theranostics"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Xue, J.S., Yang, Y., Li, Z., Wang, X., Chen, H., and Zhao, Y. (2025). Management of liver metastases from non-functional gastroenteropancreatic neuroendocrine tumors: A systematic review. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1601185"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1056\/NEJMoa1009290","article-title":"Everolimus for advanced pancreatic neuroendocrine tumors","volume":"364","author":"Yao","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/S0140-6736(15)00817-X","article-title":"Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): A randomised, placebo-controlled, phase 3 study","volume":"387","author":"Yao","year":"2016","journal-title":"Lancet"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1056\/NEJMoa1003825","article-title":"Sunitinib malate for the treatment of pancreatic neuroendocrine tumors","volume":"364","author":"Raymond","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_52","first-page":"510","article-title":"A case of successful conversion from everolimus to surgical resection of a giant pancreatic neuroendocrine tumor","volume":"10","author":"Sato","year":"2017","journal-title":"Clin. J. Gastroenterol."},{"key":"ref_53","first-page":"92","article-title":"Surgery after sunitinib administration to improve survival of patients with advanced pancreatic neuroendocrine neoplasms","volume":"6","author":"Murase","year":"2021","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1136\/gutjnl-2020-322595","article-title":"Non-functional pancreatic neuroendocrine tumours: ATRX\/DAXX and alternative lengthening of telomeres (ALT) are prognostically independent from ARX\/PDX1 expression and tumour size","volume":"71","author":"Hackeng","year":"2022","journal-title":"Gut"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.humpath.2022.07.015","article-title":"The diagnostic and prognostic utility of incorporating DAXX\/ATRX and alternative lengthening of telomeres to the evaluation of pancreatic neuroendocrine tumors","volume":"129","author":"Heaphy","year":"2023","journal-title":"Hum. Pathol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"7506","DOI":"10.1245\/s10434-021-10021-1","article-title":"Early identification of residual disease after neuroendocrine tumor resection using a liquid biopsy multigenomic mRNA signature (NETest)","volume":"28","author":"Modlin","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Rossi, R.E., Invernizzi, P., Mazzaferro, V., and Massironi, S. (2025). NETest and gastro-entero-pancreatic neuroendocrine tumors: Still far from routine clinical application?. Genes, 16.","DOI":"10.3390\/genes16020161"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e240065","DOI":"10.1530\/ERC-24-0065","article-title":"MEN1\/DAXX\/ATRX mutations enhance progression-free survival in gastroenteropancreatic neuroendocrine tumors treated with peptide receptor radionuclide therapy","volume":"31","author":"Gujarathi","year":"2024","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.annonc.2020.03.304","article-title":"Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"Pavel","year":"2020","journal-title":"Ann. 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