Analysis of prognostic factors for advanced pancreatic neuroendocrine carcinoma: A population-based study

Pancreatic neuroendocrine carcinoma (PNEC) is a rare and aggressive malignancy with poor prognosis. However, large-scale studies on the prognostic factors of PNEC remain limited. We retrospectively extracted clinical data of patients diagnosed with PNEC between 2004 and 2021 from the surveillance, epidemiology, and end results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using Kaplan-Meier method and compared by log-rank test. Univariate and multivariate Cox proportional-hazards regression models were employed to identify independent prognostic factors. Among 2089 included patients with PNEC, the median age was 61 years (range: 11-90 years). The median OS was 13.0 months, with 1-, 3-, and 5-year OS rates of 51.3%, 29.1%, and 20.1%, respectively. The median CSS was 14.0 months, with corresponding 1-, 3-, and 5-year CSS rates of 53.0%, 31.2%, and 21.9%, respectively. Multivariate analysis identified that advanced age (HR = 1.02, 95% CI: 1.01-1.03, P < .001), poor histological differentiation (HR = 1.35, 95% CI: 1.12-1.63, P = .002), primary tumor located in the head (HR = 1.28, 95% CI: 1.09-1.51, P = .003) or body (HR = 1.42, 95% CI: 1.15-1.75, P = .001) of the pancreas, regional lymph node metastasis (HR = 1.32, 95% CI: 1.14-1.53, P < .001), absence of primary site surgery (HR = 2.15, 95% CI: 1.82-2.54, P < .001), and absence of chemotherapy (HR = 1.87, 95% CI: 1.63-2.15, P < .001) were independent prognostic factors associated with worse OS and CSS. Patients with PNEC have poor prognosis with median survival of approximately 13 months. Several clinicopathological factors including age, tumor differentiation, tumor location, lymph node status, and treatment modalities were identified as independent prognostic indicators. These findings provide valuable insights for prognostic stratification and treatment decision-making in patients with PNEC.