Age Influence on the Prognosis and Management of Non-Functional Pancreatic Neuroendocrine Tumors in the Elderly

Abstract Introduction Pancreatic neuroendocrine tumors (PanNETs) account for about 7% of pancreatic tumors and are increasing in incidence. Non-functional PanNETs in the elderly often present asymptomatically, leading to more conservative treatment due to age bias. The impact of age on prognosis and management needs further clarification. Methods Clinical data for patients over 65 with non-functional PanNETs were collected from the SEER database. Kaplan-Meier curves analyzed overall survival between younger elderly (age 65–75 years) and older elderly (age ≥ 75 years) groups. Competing risk models assessed cancer-specific mortality, and Cox regression models identified independent survival risk factors. A prognostic model was constructed and evaluated for performance. Results Among 2,157 patients, older elderly patients (n = 695) had larger tumors, poorer differentiation, worse M stage, and lower surgery rates compared to younger elderly patients (n = 1,462). Younger elderly had better overall survival (p < 0.0001) and lower cancer-specific mortality. Surgery improved survival in younger elderly (p < 0.0001), with no age group survival difference in non-surgical patients. Cox regression identified age > 75, male, higher grades, advanced TNM stage, N1 stage, and lack of surgery as significant risk factors. A predictive model with a C-index of 0.77 was developed. Conclusion Age is an independent prognostic factor for elderly patients with non-functional PanNETs. Younger elderly patients benefit more from surgical treatment.