{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T13:06:38Z","timestamp":1779973598765,"version":"3.53.1"},"reference-count":89,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Neuroendocrine tumors (NETs) constitute a heterogeneous and predominantly malignant group of neuroendocrine neoplasms that arise from endocrine cells dispersed throughout the body. Their clinical presentation, biological behavior, prognosis, and therapeutic management vary considerably depending on the primary tumor location and hormonal activity. Despite substantial progress in understanding the biology of NETs, identifying reliable molecular biomarkers for diagnosis, prognosis, and prediction of treatment response remains a major challenge. Increasing attention has therefore been devoted to the molecular characterization of NETs, with particular focus on recurrent genetic alterations that may contribute to tumor initiation and progression. In this review, we summarize current knowledge and recent findings referring to certain genes involved in the tumorigenesis of pancreatic and intestinal neuroendocrine tumors. We chose the genes based on data from the COSMIC (Catalogue of Somatic Mutations in Cancer) database, which compiles somatic mutations identified across numerous human cancers. We outline the biological functions of these changes and discuss their potential prognostic and predictive role as molecular markers. We also discuss their clinical relevance in both sporadic and familial forms of NETs, alongside their implications for future research and personalized management strategies.<\/jats:p>","DOI":"10.3390\/ijms27114874","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:09:07Z","timestamp":1779970147000},"page":"4874","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic and Predictive Significance of Selected Gene Mutations in Pancreatic and Intestinal Neuroendocrine Tumors"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2449-3324","authenticated-orcid":false,"given":"Jan","family":"Musia\u0142kiewicz","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2860-395X","authenticated-orcid":false,"given":"Bart\u0142omiej","family":"Budny","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Anio\u0142a","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5381-3211","authenticated-orcid":false,"given":"Adam","family":"Maciejewski","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6548-0613","authenticated-orcid":false,"given":"Pawe\u0142","family":"Komarnicki","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Maciejewska","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Gut","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6296-7220","authenticated-orcid":false,"given":"Marek","family":"Rucha\u0142a","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12022-022-09708-2","article-title":"Overview of the 2022 WHO Classification of Neuroendocrine Neoplasms","volume":"33","author":"Rindi","year":"2022","journal-title":"Endocr. Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/CEJ.0000000000000877","article-title":"Incidence trend of neuroendocrine tumors and disparities by sex and race\/ethnicity in adults from the United States, 2000\u20132020","volume":"33","author":"Zhu","year":"2024","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1002\/cncr.29099","article-title":"Exploring the rising incidence of neuroendocrine tumors: A population-based analysis of epidemiology, metastatic presentation, and outcomes","volume":"121","author":"Hallet","year":"2015","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4519","DOI":"10.3748\/wjg.v16.i36.4519","article-title":"Recent standardization of treatment strategy for pancreatic neuroendocrine tumors","volume":"16","author":"Imamura","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.neo.2017.09.002","article-title":"Nothing But NET: A Review of Neuroendocrine Tumors and Carcinomas","volume":"19","author":"Oronsky","year":"2017","journal-title":"Neoplasia"},{"key":"ref_6","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_7","doi-asserted-by":"crossref","first-page":"e13146","DOI":"10.1111\/jne.13146","article-title":"European Neuroendocrine Tumor Society (ENETS) 2022 Guidance Paper for Carcinoid Syndrome and Carcinoid Heart Disease","volume":"34","author":"Davar","year":"2022","journal-title":"J. Neuroendocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.semcancer.2025.03.005","article-title":"Pancreatic neuroendocrine neoplasms (pNENs): Genetic and environmental biomarkers for risk of occurrence and prognosis","volume":"112","author":"Tacelli","year":"2025","journal-title":"Semin. Cancer Biol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"387","DOI":"10.5603\/EP.a2022.0049","article-title":"Update of the diagnostic and therapeutic guidelines for gastro-entero-pancreatic neuroendocrine neoplasms (recommended by the Polish Network of Neuroendocrine Tumours)","volume":"73","author":"Foltyn","year":"2022","journal-title":"Endokrynol. Pol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"682","DOI":"10.5603\/ep.106855","article-title":"Severe secretory diarrhea due to VIPoma","volume":"76","author":"Gierach","year":"2025","journal-title":"Endokrynol. Pol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Komarnicki, P., Musia\u0142kiewicz, J., Sta\u0144ska, A., Maciejewski, A., Gut, P., Mastorakos, G., and Rucha\u0142a, M. (2022). Circulating Neuroendocrine Tumor Biomarkers: Past, Present and Future. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195542"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e210647","DOI":"10.1530\/EC-21-0647","article-title":"Serum levels of neuron-specific enolase as a prognostic factor for disease progression in patients with GET\/NEN in the pancreas and the small intestine","volume":"11","author":"Fuksiewicz","year":"2022","journal-title":"Endocr. Connect."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Komarnicki, P., Gut, P., Cie\u015blewicz, M., Musia\u0142kiewicz, J., Maciejewski, A., Czupi\u0144ska, M., Mastorakos, G., and Rucha\u0142a, M. (2024). Serum \u03b2-hCG as a Biomarker in Pancreatic Neuroendocrine Tumors: Rethinking Single-Analyte Approach. Cancers, 16.","DOI":"10.3390\/cancers16112060"},{"key":"ref_14","first-page":"e250350","article-title":"Longitudinal analysis of serum alpha-fetoprotein in stable and progressive metastatic pancreatic neuroendocrine tumours","volume":"14","author":"Komarnicki","year":"2025","journal-title":"Endocr. Connect."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Komarnicki, P., Maciejewski, A., Musia\u0142kiewicz, J., Czupi\u0144ska, M., Mastorakos, G., Rucha\u0142a, M., and Gut, P. (2025). Serum Visfatin\/eNAMPT as a Biomarker in Pancreatic and Small Intestine Neuroendocrine Tumors: A Cross-Sectional Study and Future Perspectives. Cancers, 17.","DOI":"10.3390\/cancers17142343"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1159\/000518873","article-title":"NETest: A Systematic Review Focusing on the Prognostic and Predictive Role","volume":"112","author":"Puliani","year":"2022","journal-title":"Neuroendocrinology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.advms.2019.10.002","article-title":"The clinical applications of a multigene liquid biopsy (NETest) in neuroendocrine tumors","volume":"65","author":"Malczewska","year":"2020","journal-title":"Adv. Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Almeida, C., Gervaso, L., Frig\u00e8, G., Spada, F., Benini, L., Cella, C.A., Mazzarella, L., and Fazio, N. (2024). The Role of Liquid Biopsy in Gastroenteropancreatic Neuroendocrine Neoplasms. Cancers, 16.","DOI":"10.3390\/cancers16193349"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1111\/cen.14094","article-title":"What is the appropriate management of nonfunctioning pancreatic neuroendocrine tumours disclosed on screening in adult patients with multiple endocrine neoplasia type 1?","volume":"91","author":"Challis","year":"2019","journal-title":"Clin. Endocrinol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s11154-019-09508-w","article-title":"Clinical applications of (epi)genetics in gastroenteropancreatic neuroendocrine neoplasms: Moving towards liquid biopsies","volume":"20","author":"Boons","year":"2019","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s12022-013-9295-2","article-title":"Neuroendocrine tumors of the pancreas: Current concepts and controversies","volume":"25","author":"Reid","year":"2014","journal-title":"Endocr. Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.beem.2010.07.003","article-title":"Multiple endocrine neoplasia type 1 (MEN1)","volume":"24","author":"Thakker","year":"2010","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_23","first-page":"83","article-title":"Clear cell neuroendocrine tumor of the pancreas in von Hippel-Lindau disease: A case report and literature review","volume":"38","author":"Woo","year":"2017","journal-title":"Neuro Endocrinol. Lett."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1016\/j.ijsu.2015.04.089","article-title":"Conservative management and parenchyma-sparing resections of pancreatic neuroendocrine tumors: Literature review","volume":"21","author":"Mauriello","year":"2015","journal-title":"Int. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1007\/s00268-017-4435-3","article-title":"From Initial Description by Wermer to Present-Day MEN1: What have We Learned?","volume":"42","author":"Perrier","year":"2018","journal-title":"World J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Welsch, C., Fl\u00fcgel, A.K., Rondot, S., Schulze, E., Sircar, I., Nu\u00dfbaumer, J., and Bojunga, J. (2022). Distinct clinical phenotypes in a family with a novel truncating MEN1 frameshift mutation. BMC Endocr. Disord., 22.","DOI":"10.1186\/s12902-022-00978-9"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/PAP.0000000000000201","article-title":"Neoplasms of the Neuroendocrine Pancreas: An Update in the Classification, Definition, and Molecular Genetic Advances","volume":"26","author":"Guilmette","year":"2019","journal-title":"Adv. Anat. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.semcancer.2021.04.011","article-title":"Multiple endocrine neoplasia type 1 (MEN-1) and neuroendocrine neoplasms (NENs)","volume":"79","author":"Effraimidis","year":"2022","journal-title":"Semin. Cancer Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/MD.0b013e3182954af1","article-title":"Causes of death and prognostic factors in multiple endocrine neoplasia type 1: A prospective study: Comparison of 106 MEN1\/Zollinger-Ellison syndrome patients with 1613 literature MEN1 patients with or without pancreatic endocrine tumors","volume":"92","author":"Ito","year":"2013","journal-title":"Medicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"R161","DOI":"10.1530\/JOE-17-0560","article-title":"Genomic landscape of pancreatic neuroendocrine tumours: The International Cancer Genome Consortium","volume":"236","author":"Mafficini","year":"2018","journal-title":"J. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4143\/crt.2019.192","article-title":"Pancreatic High-Grade Neuroendocrine Neoplasms in the Korean Population: A Multicenter Study","volume":"52","author":"Kim","year":"2020","journal-title":"Cancer Res. Treat."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1007\/s12020-017-1327-0","article-title":"Pancreatic neuroendocrine tumors in MEN1 disease: A mono-centric longitudinal and prognostic study","volume":"60","author":"Chiloiro","year":"2018","journal-title":"Endocrine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"93464","DOI":"10.18632\/oncotarget.18750","article-title":"Assessment of pancreatic neuroendocrine tumor cytologic genotype diversity to guide personalized medicine using a custom gastroenteropancreatic next-generation sequencing panel","volume":"8","author":"Gleeson","year":"2017","journal-title":"Oncotarget"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1309\/AJCP0FKDP7ENVKEV","article-title":"Molecular genetics of pancreatic neoplasms and their morphologic correlates: An update on recent advances and potential diagnostic applications","volume":"141","author":"Reid","year":"2014","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"bvaf147","DOI":"10.1210\/jendso\/bvaf147","article-title":"MEN1-Related Neuroendocrine Tumors Show c-MET Overexpression","volume":"9","author":"Ghosh","year":"2025","journal-title":"J. Endocr. Soc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1210\/jc.2017-02434","article-title":"In silico VHL Gene Mutation Analysis and Prognosis of Pancreatic Neuroendocrine Tumors in von Hippel-Lindau Disease","volume":"103","author":"Tirosh","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"437","DOI":"10.5858\/arpa.2015-0314-RA","article-title":"Recent Updates on Neuroendocrine Tumors From the Gastrointestinal and Pancreatobiliary Tracts","volume":"140","author":"Kim","year":"2016","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s12020-021-02752-8","article-title":"Clinical presentation, genotype-phenotype correlations, and outcome of pancreatic neuroendocrine tumors in Von Hippel-Lindau syndrome","volume":"74","author":"Penitenti","year":"2021","journal-title":"Endocrine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1002\/cncr.33978","article-title":"Management recommendations for pancreatic manifestations of von Hippel-Lindau disease","volume":"128","author":"Laks","year":"2022","journal-title":"Cancer"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1159\/000480239","article-title":"18F-FDG Uptake in Well-Differentiated Neuroendocrine Tumors Correlates with Both Ki-67 and VHL Pathway Inactivation","volume":"106","author":"Bucau","year":"2018","journal-title":"Neuroendocrinology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.pan.2016.01.011","article-title":"Molecular alterations in sporadic pancreatic neuroendocrine microadenomas","volume":"16","author":"Hadano","year":"2016","journal-title":"Pancreatology"},{"key":"ref_42","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":"2022","journal-title":"Hum. Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1097\/MPA.0000000000001256","article-title":"Performance of DAXX Immunohistochemistry as a Screen for DAXX Mutations in Pancreatic Neuroendocrine Tumors","volume":"48","author":"Hechtman","year":"2019","journal-title":"Pancreas"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1007\/s11912-021-01096-w","article-title":"Alternative Lengthening of Telomeres (ALT) in Pancreatic Neuroendocrine Tumors: Ready for Prime-Time in Clinical Practice?","volume":"23","author":"Luchini","year":"2021","journal-title":"Curr. Oncol. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1053\/j.gastro.2013.10.020","article-title":"Loss of DAXX and ATRX are associated with chromosome instability and reduced survival of patients with pancreatic neuroendocrine tumors","volume":"146","author":"Marinoni","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.2214\/AJR.17.19490","article-title":"CT Radiogenomic Characterization of the Alternative Lengthening of Telomeres Phenotype in Pancreatic Neuroendocrine Tumors","volume":"211","author":"McGovern","year":"2018","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1097\/SLA.0000000000003022","article-title":"Genetic Analysis of Small Well-differentiated Pancreatic Neuroendocrine Tumors Identifies Subgroups With Differing Risks of Liver Metastases","volume":"271","author":"Pea","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s12022-020-09611-8","article-title":"Alternative Lengthening of Telomeres and Differential Expression of Endocrine Transcription Factors Distinguish Metastatic and Non-metastatic Insulinomas","volume":"31","author":"Hackeng","year":"2020","journal-title":"Endocr. Pathol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1158\/1078-0432.CCR-16-1113","article-title":"Alternative Lengthening of Telomeres and Loss of DAXX\/ATRX Expression Predicts Metastatic Disease and Poor Survival in Patients with Pancreatic Neuroendocrine Tumors","volume":"23","author":"Singhi","year":"2017","journal-title":"Clin. Cancer Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1016\/j.humpath.2013.04.025","article-title":"Clinicopathologic significance of immunostaining of \u03b1-thalassemia\/mental retardation syndrome X-linked protein and death domain-associated protein in neuroendocrine tumors","volume":"44","author":"Chen","year":"2013","journal-title":"Hum. Pathol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1053\/j.gastro.2018.02.026","article-title":"Loss of Chromatin-Remodeling Proteins and\/or CDKN2A Associates With Metastasis of Pancreatic Neuroendocrine Tumors and Reduced Patient Survival Times","volume":"154","author":"Roy","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_52","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_53","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.pan.2023.05.002","article-title":"Endoscopic ultrasound fine-needle biopsy to assess DAXX\/ATRX expression and alternative lengthening of telomeres status in non-functional pancreatic neuroendocrine tumors","volume":"23","author":"Mastrosimini","year":"2023","journal-title":"Pancreatology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s12022-024-09826-z","article-title":"Glucagon-producing pancreatic neuroendocrine tumors (glucagonomas) are enriched in aggressive neoplasms with ARX and PDX1 co-expression, DAXX\/ATRX mutations, and ALT (alternative lengthening of telomeres)","volume":"35","author":"Mattiolo","year":"2024","journal-title":"Endocr. Pathol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1136\/gutjnl-2018-317233","article-title":"Whole-genome sequencing reveals distinct genetic bases for insulinomas and non-functional pancreatic neuroendocrine tumours: Leading to a new classification system","volume":"69","author":"Hong","year":"2020","journal-title":"Gut"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1002\/jhbp.26","article-title":"Mammalian target of rapamycin signaling activation patterns in pancreatic neuroendocrine tumors","volume":"21","author":"Komori","year":"2014","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"7872519","DOI":"10.1155\/2017\/7872519","article-title":"Determination of Mammalian Target of Rapamycin Hyperactivation as Prognostic Factor in Well-Differentiated Neuroendocrine Tumors","volume":"2017","author":"Lamberti","year":"2017","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3418","DOI":"10.1200\/JCO.2012.46.6946","article-title":"Prognostic significance of MTOR pathway component expression in neuroendocrine tumors","volume":"31","author":"Qian","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Gelsomino, F., Casadei-Gardini, A., Caputo, F., Rossi, G., Bertolini, F., Petrachi, T., Spallanzani, A., Pettorelli, E., Kaleci, S., and Luppi, G. (2020). mTOR Pathway Expression as Potential Predictive Biomarker in Patients with Advanced Neuroendocrine Tumors Treated with Everolimus. Cancers, 12.","DOI":"10.3390\/cancers12051201"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1055\/s-0031-1291333","article-title":"Loss of PTEN expression in neuroendocrine pancreatic tumors","volume":"43","author":"Krausch","year":"2011","journal-title":"Horm. Metab. Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1200\/JCO.2008.21.5988","article-title":"Pancreatic endocrine tumors: Expression profiling evidences a role for AKT-mTOR pathway","volume":"28","author":"Missiaglia","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.5858\/arpa.2013-0195-OA","article-title":"Progesterone receptor and PTEN expression predict survival in patients with low- and intermediate-grade pancreatic neuroendocrine tumors","volume":"138","author":"Estrella","year":"2014","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.4158\/EP13010.CR","article-title":"Pancreatic neuroendocrine tumor in a child with a tuberous sclerosis complex 2 (TSC2) mutation","volume":"19","author":"Bombardieri","year":"2013","journal-title":"Endocr. Pract."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/j.1399-0004.2011.01805.x","article-title":"Pancreatic neuroendocrine tumors in patients with tuberous sclerosis complex","volume":"82","author":"Larson","year":"2012","journal-title":"Clin. Genet."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1159\/000481390","article-title":"Neuroendocrine Neoplasms: Dichotomy, Origin and Classifications","volume":"33","year":"2017","journal-title":"Visc. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s00428-021-03202-6","article-title":"An analysis of 130 neuroendocrine tumors G3 regarding prevalence, origin, metastasis, and diagnostic features","volume":"480","author":"Kasajima","year":"2022","journal-title":"Virchows Arch."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/j.pan.2020.07.400","article-title":"Pancreatic neuroendocrine carcinoma G3 may be heterogeneous and could be classified into two distinct groups","volume":"20","author":"Tanaka","year":"2020","journal-title":"Pancreatology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1038\/modpathol.2016.217","article-title":"Somatostatin receptor expression related to TP53 and RB1 alterations in pancreatic and extrapancreatic neuroendocrine neoplasms with a Ki67-index above 20%","volume":"30","author":"Konukiewitz","year":"2017","journal-title":"Mod. Pathol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"4625","DOI":"10.1158\/1078-0432.CCR-16-3135","article-title":"Rb Loss and KRAS Mutation Are Predictors of the Response to Platinum-Based Chemotherapy in Pancreatic Neuroendocrine Neoplasm with Grade 3: A Japanese Multicenter Pancreatic NEN-G3 Study","volume":"23","author":"Hijioka","year":"2017","journal-title":"Clin. Cancer Res."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.humpath.2018.03.018","article-title":"Pancreatic neuroendocrine carcinomas reveal a closer relationship to ductal adenocarcinomas than to neuroendocrine tumors G3","volume":"77","author":"Konukiewitz","year":"2018","journal-title":"Hum. Pathol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1002\/path.6291","article-title":"PCDHGC3 hypermethylation as a potential biomarker of intestinal neuroendocrine carcinomas","volume":"263","author":"Cubiella","year":"2024","journal-title":"J. Pathol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s12664-024-01678-z","article-title":"Prognostic and predictive significance of p53 and ATRX in neuroendocrine neoplasms of GIT and pancreas and their utility as an adjunct to accurate diagnosis-An eight-year retrospective study","volume":"44","author":"Ail","year":"2025","journal-title":"Indian J. Gastroenterol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s12022-024-09827-y","article-title":"Rapid evolution of metastases in patients with treated G3 neuroendocrine tumors associated with NEC-like transformation and TP53 mutation","volume":"35","author":"Kasajima","year":"2024","journal-title":"Endocr. Pathol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1097\/PAS.0000000000000662","article-title":"A practical approach to the classification of WHO grade 3 (G3) well-differentiated neuroendocrine tumor (WD-NET) and poorly differentiated neuroendocrine carcinoma (PD-NEC) of the pancreas","volume":"40","author":"Tang","year":"2016","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1159\/000497153","article-title":"Ancillary techniques in cytologic specimens obtained from solid lesions of the pancreas: A review","volume":"64","author":"Heymann","year":"2020","journal-title":"Acta Cytol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.surg.2016.09.002","article-title":"Loss of DPC4\/SMAD4 expression in primary gastrointestinal neuroendocrine tumors is associated with cancer-related death after resection","volume":"161","author":"Roland","year":"2017","journal-title":"Surgery"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1097\/MPA.0000000000001030","article-title":"Site-specific genomic alterations in a well-differentiated pancreatic neuroendocrine tumor with high-grade progression","volume":"47","author":"Martin","year":"2018","journal-title":"Pancreas"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/MPA.0000000000001535","article-title":"Aberration of ARID1A is associated with the tumorigenesis and prognosis of sporadic nonfunctional pancreatic neuroendocrine tumors","volume":"49","author":"Han","year":"2020","journal-title":"Pancreas"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ando.2019.04.010","article-title":"The landscape of molecular alterations in pancreatic and small intestinal neuroendocrine tumours","volume":"80","author":"Scarpa","year":"2019","journal-title":"Ann. Endocrinol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1158\/1078-0432.CCR-15-0373","article-title":"Prognostic impact of novel molecular subtypes of small intestinal neuroendocrine tumor","volume":"22","author":"Karpathakis","year":"2016","journal-title":"Clin. Cancer Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"987","DOI":"10.4161\/epi.28936","article-title":"DNA hypomethylation and promoter methylation in small intestinal neuroendocrine tumors: An in vivo and in vitro study","volume":"9","author":"Fotouhi","year":"2014","journal-title":"Epigenetics"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1111\/his.14252","article-title":"Driver mutations occur frequently in metastases of well-differentiated small intestine neuroendocrine tumours","volume":"78","author":"Samsom","year":"2021","journal-title":"Histopathology"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1038\/ng.2821","article-title":"Somatic mutation of CDKN1B in small intestine neuroendocrine tumors","volume":"45","author":"Francis","year":"2013","journal-title":"Nat. Genet."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"417","DOI":"10.12688\/f1000research.130251.2","article-title":"Multiomic sequencing of paired primary and metastatic small bowel carcinoids","volume":"12","author":"Postel","year":"2023","journal-title":"F1000Research"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s00428-018-2450-x","article-title":"Mutational and copy number asset of primary sporadic neuroendocrine tumors of the small intestine","volume":"473","author":"Simbolo","year":"2018","journal-title":"Virchows Arch."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1245\/s10434-014-4351-9","article-title":"Somatic mutations and genetic heterogeneity at the CDKN1B locus in small intestinal neuroendocrine tumors","volume":"22","author":"Crona","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"S126","DOI":"10.1016\/j.jamcollsurg.2014.07.301","article-title":"Somatic alterations of CDKN1B are associated with small bowel neuroendocrine tumors","volume":"219","author":"Maxwell","year":"2014","journal-title":"J. Am. Coll. Surg."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"6367","DOI":"10.1038\/s41467-021-26581-5","article-title":"Independent somatic evolution underlies clustered neuroendocrine tumors in the human small intestine","volume":"12","author":"Elias","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1016\/j.humpath.2013.06.019","article-title":"Adenomatous polyposis coli gene involvement in ileal enterochromaffin cell neuroendocrine neoplasms","volume":"44","author":"Bottarelli","year":"2013","journal-title":"Hum. Pathol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/11\/4874\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:11:31Z","timestamp":1779970291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/11\/4874"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":89,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijms27114874"],"URL":"https:\/\/doi.org\/10.3390\/ijms27114874","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}