Real-world impact of metabolic, renal, and demographic factors on overall survival in well- to moderately differentiated gastrointestinal and pancreatic neuroendocrine tumors.

e16326 Background: Well- to moderately differentiated gastrointestinal and pancreatic neuroendocrine tumors (NETs) show substantial heterogeneity in clinical outcomes. While tumor-related characteristics are established prognostic factors, the impact of patient-level comorbidities, metabolic factors, and sociodemographic characteristics on overall survival (OS) remains incompletely described. We evaluated OS across clinical, metabolic, renal, and demographic subgroups in a real- world cohort of patients with well- to moderately differentiated NETs. Methods: We conducted a retrospective cohort study using a harmonized clinical dataset spanning diagnosis, physical assessment, laboratory, and demographic domains. The cohort included adult patients with well- to moderately differentiated NETs of pancreatic and gastrointestinal origin; poorly differentiated tumors were excluded. Baseline characteristics, including body mass index (BMI, categorized as < 25 vs. ≥25 kg/m²), smoking status (ever vs. never), age at primary diagnosis, and race/ethnicity, were extracted. Advanced kidney disease (AKD) was defined as serum creatinine > 1.5 mg/dL on ≥2 occasions. OS was estimated with the Kaplan-Meier method, and differences were assessed with the log-rank test. Results: The cohort included 132 patients (Oncology Research Information Exchange Network, ORIEN). Overall survival was significantly worse in patients aged ≥50 years, with a shorter median OS than in patients younger than 50 years. For patients who were 50 or older at primary diagnosis, the median overall survival was 14.46 years, whereas for those younger than 50, the median OS was not reached(p = 0.046). There was no significant difference in median OS based on other clinical factors, including BMI, smoking status, advanced kidney disease, and race/ethnicity. Conclusions: In this real-world analysis of patients with GEP-NETs, age was the dominant predictor of overall survival.Traditional metabolic and renal risk factors did not demonstrate significant prognostic value in this cohort, suggesting that tumor biology or age-related background mortality may outweigh these comorbidities in this setting. Future studies utilizing larger, multi-institutional datasets are warranted to perform multivariate adjustments and isolate disease-specific survival outcomes.