Survival over two decades in neuroendocrine neoplasms care

Abstract Background The incidence of gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs) has increased, alongside novel therapies and care models. Whether these advances translated into improved survival is unclear. Methods Population-based retrospective cohort study of GEP-NENs between 2000–2019. Overall survival (OS) was analyzed using time-to-event methods. Restricted cubic splines assessed non-linear associations between diagnosis year and hazards of death; multivariable Cox regression adjusted for age, sex, primary site, and metastatic status. Results Among 9,420 patients, 5-year OS was 75.8% overall, 88.8% for non-metastatic disease, and 57.0% for metastatic disease. Mortality risk declined in more recent years, with diagnoses in 2013–2019 associated with lower hazards of death (adjusted HR 0.91, 95%CI 0.83–0.99). Improvements were confined to non-metastatic disease and to pancreas, stomach, and rectal primaries. Conclusion OS has modestly improved over two decades, largely reflecting stage migration rather than clear therapeutic gains. Advances that meaningfully improve survival in advanced GEP-NENs are needed.