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Background <p>High-grade pancreatic neuroendocrine neoplasms (panNENs) are rare but aggressive tumors with poor clinical outcomes. Metabolic alterations are frequently observed in panNENs and may reflect their metabolic reprogramming. Significant intra-pancreatic fat deposition (IPFD), defined as excessive pancreatic fat accumulation, has been linked to various pancreatic diseases and identified as a prognostic factor in pancreatic cancer.</p> Objective <p>This retrospective multicenter study aimed to evaluate the prognostic value of metabolic alterations, particularly significant IPFD, in patients with high-grade panNENs.</p> Methods <p>Between 2013 and 2024, 87 patients with high-grade panNENs from three centers were included. Significant IPFD was assessed on unenhanced computed tomography images, with a pancreas-to-spleen attenuation ratio &lt;0.70. Other metabolic data were retrospectively obtained from previous clinical assessments and medical records.</p> Results <p>Among 87 patients, 24 (27.6%) showed significant IPFD. Patients with significant IPFD were associated with tumors located in the pancreatic head (75.0% vs 49.2%, P = 0.030) and a higher prevalence of metabolic dysfunction-associated steatotic liver disease (20.8% vs 3.2%, P = 0.023). After adjustment for tumor differentiation and clinical stage, significant IPFD independently predicted worse overall survival (hazard ratio [HR] 2.134; 95% confidence interval [CI] 1.159–3.929, P = 0.015) and disease-specific survival (HR 2.167; 95% CI 1.137–4.133, P = 0.019). In contrast, other metabolic alterations, including obesity and metabolic syndrome, were not independently associated with survival.</p> Conclusions <p>Significant IPFD is an independent adverse prognostic factor for overall and disease-specific survival in patients with high-grade panNENs, highlighting its potential role in risk stratification and clinical decision-making.</p>

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Significant Intra-pancreatic Fat Deposition as an Independent Prognostic Factor in High-grade Pancreatic Neuroendocrine Neoplasms

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Changhao Gao,
  • Zhiyao Fan,
  • Longjia Zhang,
  • Qingdi Qin,
  • Zhenya Liu,
  • Runxian Wang,
  • Jiankang Zhu,
  • Bin Zhou,
  • Hanxiang Zhan

摘要

Background

High-grade pancreatic neuroendocrine neoplasms (panNENs) are rare but aggressive tumors with poor clinical outcomes. Metabolic alterations are frequently observed in panNENs and may reflect their metabolic reprogramming. Significant intra-pancreatic fat deposition (IPFD), defined as excessive pancreatic fat accumulation, has been linked to various pancreatic diseases and identified as a prognostic factor in pancreatic cancer.

Objective

This retrospective multicenter study aimed to evaluate the prognostic value of metabolic alterations, particularly significant IPFD, in patients with high-grade panNENs.

Methods

Between 2013 and 2024, 87 patients with high-grade panNENs from three centers were included. Significant IPFD was assessed on unenhanced computed tomography images, with a pancreas-to-spleen attenuation ratio <0.70. Other metabolic data were retrospectively obtained from previous clinical assessments and medical records.

Results

Among 87 patients, 24 (27.6%) showed significant IPFD. Patients with significant IPFD were associated with tumors located in the pancreatic head (75.0% vs 49.2%, P = 0.030) and a higher prevalence of metabolic dysfunction-associated steatotic liver disease (20.8% vs 3.2%, P = 0.023). After adjustment for tumor differentiation and clinical stage, significant IPFD independently predicted worse overall survival (hazard ratio [HR] 2.134; 95% confidence interval [CI] 1.159–3.929, P = 0.015) and disease-specific survival (HR 2.167; 95% CI 1.137–4.133, P = 0.019). In contrast, other metabolic alterations, including obesity and metabolic syndrome, were not independently associated with survival.

Conclusions

Significant IPFD is an independent adverse prognostic factor for overall and disease-specific survival in patients with high-grade panNENs, highlighting its potential role in risk stratification and clinical decision-making.