Wang H, Ding D, Qin T, et al. - Improvements for pancreatic neuroendocrine tumors (pNETs) staging have been introduced in the American Joint Committee on Cancer (AJCC) 8 ^th Edition; however, multicenter studies were not included. This study using multicenter datasets revealed that AJCC 8 not only had a more reasonable proportional distribution but also the risk of death was better correlated with disease stage.

• Multicenter datasets (n=1,086, between 2004 and 2018) were obtained to validate the value of AJCC 8 as well as other coexisting staging systems for well-differentiated (G1/G2) pNETs.

• Relative to other coexisting staging systems, AJCC 7 only included 12 (1.1%) patients with stage III tumors.

• A higher risk of death was observed in patients with European Neuroendocrine Tumor Society (ENETS) stage IIB disease vs those with stage IIIA (hazard ratio [HR]: 4.376 vs 4.322).

• The risk of death was higher in stage IIB disease vs stage III (HR: 6.078 vs 5.341) for the modified ENETS staging system.

• By AJCC 8, the proportion of patients with stage I disease was 25.7%, and it was 40.3%, 23.6%, and 10.4% for stage II, III, and IV, respectively.

• With the advancement of stage, reduction in median survival time (NA, 144.7, 100.8, 72.0 months, respectively) as well as increase in the risk of death was evident (HR: II=3.145, III=5.925, and IV=8.762).