Real-world treatment outcomes for pancreatic neuroendocrine tumours: a single tertiary referral institute experience

<h3>Background</h3> Pancreatic neuroendocrine tumours (PNETs) are rare neoplasms of the pancreas. Real-world treatment outcomes in Asia are seldom reported. The aim of this study was to provide the real-world treatment outcomes of PNETs at a single tertiary cancer centre in Hong Kong over an 18-year period. <h3>Materials and methods</h3> This was a retrospective cohort study that recruits patients with local or metastatic PNETs treated at Prince of Wales Hospital, Hong Kong between 2005 and 2023. Five-year overall survival (OS), progression-free survival (PFS), recurrence-free survival (RFS) of the surgical cohort, and survival outcomes in patients with metastatic disease were summarized. <h3>Results</h3> A total of 98 patients were recruited (median age: 59 years, 51% male). Among them, 18 patients (18.4%) had functioning tumours, of which majority were insulinoma (72.2%). Most tumours (64.8%) were classified as grade 1 disease. More than 80% of patients had early-stage disease on presentation, with only 14 patients presented with stage IV disease. Five-year OS for the entire cohort was 88.4% and the 5-year PFS was 73.7%. Older age [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.00-1.13, <i>P</i> = 0.04] and larger tumour size (HR 1.20, 95% CI 1.00-1.44, <i>P</i> = 0.05) were associated with worse OS, whereas patients with metastatic disease had a shorter PFS (HR 7.95, 95% CI 2.55-24.8, <i>P</i> < 0.001). In the cohort treated with curative surgery, metastatic disease (HR 7.49, 95% CI 1.40-40.0, <i>P</i> = 0.018) and tumour grade (HR 8.03, 95% CI 1.58-40.8, <i>P</i> = 0.012) were associated with worse RFS. Microscopic margin involvement did not influence RFS in patients treated with curative surgery. In the 20 patients who received systemic therapy, everolimus showed a trend towards improved PFS compared with chemotherapy (5-year PFS: 46.9% versus 16.7%). <h3>Conclusion</h3> Patients with PNETs in Hong Kong have early presentation and excellent prognosis with most patients being eligible for curative surgery reaching 90% of 5-year OS.