Prognostic Factors for Neuroendocrine Tumors

The discussion focused on the key prognostic factors guiding management of neuroendocrine tumors (NETs). Dr. Arshad emphasized tumor diferentiation and Ki-67 proliferation index as the two most critical determinants of prognosis, highlighting how well-differentiated tumors with organized morphology and low atypia generally behave more indolently than poorly differentiated ones. Dr. Hendifar and others agreed that pathologic classification is fundamental but added that disease pace of growth rate observed on serial imaging provides essential real-world insight into tumor aggressiveness—especially given the heterogeneity of NETs that a single biopsy may not capture. Dr. Shaheen noted that somatostatin receptor (SSTR) expression is another powerful prognostic and predictive marker, for grade 1–2 and select grade 3 tumors, as it influences treatment options like PRRT. Dr. Chauhan added burden of disease, particularly liver involvement, as a key prognostic factor, explaining that patients with >50% hepatic disease often have worse outcomes due to risk of liver failure despite low tumor grade.