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Qi Zhang Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Hongshan Wang Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Yanhong Xie Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

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Suming Huang Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

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Ke Chen Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

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Botian Ye Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Yupeng Yang Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Jie Sun Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Hongyong He Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Fenglin Liu Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Zhenbin Shen Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Weidong Chen Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Kuntang Shen Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Yuan Ji Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

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Yihong Sun Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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activity ( 1 ). The prognosis of high-grade GEP-NENs, also known as grade 3 GEP-NENs, was much worse than that of grade 1 neuroendocrine tumors (G1 NET) and grade 2 neuroendocrine tumors (G2 NET) ( 2 , 3 , 4 ). However, the 2010 WHO classification was

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Peiwen Wu Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

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Dongjie He Department of Radiation Oncology, Tangdu Hospital, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China

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Hao Chang Department of Radiation Oncology, Tangdu Hospital, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China

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Xiaozhi Zhang Department of Radiation Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

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according to SEER records and previous reports ( 4 ). The tumors were classified as localized, regional, or distant. For tumor classification, the SEER classification scheme was used to systematically categorize cases into four grades, namely, G1, G2, G3

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Hanbaro Kim Department of Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea

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Ki Byung Song Division of Hepatobilliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

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Dae Wook Hwang Division of Hepatobilliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

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Jae Hoon Lee Division of Hepatobilliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

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Shadi Alshammary Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

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Song Cheol Kim Division of Hepatobilliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea

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.1%) patients, LVi was identified in 122 (22.5%) patients. Thirty-one (5.7%) patients had a positive resection margin. Figure 3 Evolving trend in clinicopathological features of surgically resected pancreatic neuroendocrine tumors (PNETs) during the study

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Xu Han Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Xuefeng Xu Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Hongyun Ma Department of Pancreatic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China

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Yuan Ji Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

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Dansong Wang Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Tiantao Kuang Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Wenchuan Wu Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Bin Song Department of Pancreatic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China

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Gang Li Department of Pancreatic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China

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Gang Jin Department of Pancreatic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China

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Wenhui Lou Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Z Tang LH Hruban RH Adsay V McCall CM Krasinskas AM Jang KT Frankel WL Balci S , et al . The high-grade (WHO G3) pancreatic neuroendocrine tumor category is morphologically and biologically heterogenous and includes both well differentiated and

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Kazhan Mollazadegan Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Britt Skogseid Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Johan Botling Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden

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Tobias Åkerström Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

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Barbro Eriksson Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Staffan Welin Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Anders Sundin Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

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Joakim Crona Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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grading of panNENs ( 3 ), high-grade neoplasms were separated into two categories: well-differentiated (WD) pancreatic neuroendocrine tumor grade 3 (panNET-G3) and poorly differentiated (PD) NEC ( 4 ). PanNET-G3 frequently harbors mutations in MEN1 and

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Yang Lv Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Xu Han Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Chunyan Zhang Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Shanghai, China

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Yuan Fang Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Ning Pu Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Yuan Ji Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China

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Dansong Wang Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Xu Xuefeng Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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Wenhui Lou Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

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-proliferative ability (including Ki-67 proliferation index and mitotic rate) to divide NETs into three pathological grades: G1, G2 and G3. Of these, the G3 NF-pancreatic neuroendocrine carcinomas (NECs) are defined as a tumor with Ki-67 proliferation index greater than

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Roxanne C S van Adrichem Department of Internal Medicine, Sector of Endocrinology, ENETS Centre of Excellence for Neuroendocrine Tumors, Erasmus MC, Rotterdam, The Netherlands

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Aart Jan van der Lely Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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Martin Huisman Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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Piet Kramer Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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Richard A Feelders Department of Internal Medicine, Sector of Endocrinology, ENETS Centre of Excellence for Neuroendocrine Tumors, Erasmus MC, Rotterdam, The Netherlands

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Patric J D Delhanty Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

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Wouter W de Herder Department of Internal Medicine, Sector of Endocrinology, ENETS Centre of Excellence for Neuroendocrine Tumors, Erasmus MC, Rotterdam, The Netherlands

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neuroendocrine tumors (NETs), and the distribution of plasma acylated ghrelin (AG), plasma unacylated ghrelin (UAG), and acylated ghrelin/unacylated ghrelin (AG/UAG) ratio. Data are expressed as median±interquartile range (IQR). In Fig. 3A , tumor

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Irvin M Modlin Wren Laboratories, Yale University School of Medicine, 35 NE Industrial Road, Branford, Connecticut, USA

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Harry Aslanian Wren Laboratories, Yale University School of Medicine, 35 NE Industrial Road, Branford, Connecticut, USA

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Lisa Bodei Wren Laboratories, Yale University School of Medicine, 35 NE Industrial Road, Branford, Connecticut, USA
Wren Laboratories, Yale University School of Medicine, 35 NE Industrial Road, Branford, Connecticut, USA

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Ignat Drozdov Wren Laboratories, Yale University School of Medicine, 35 NE Industrial Road, Branford, Connecticut, USA

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Mark Kidd Wren Laboratories, Yale University School of Medicine, 35 NE Industrial Road, Branford, Connecticut, USA

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)). Mean age 56.7 (range 25–82 years), gender: 40 males to 85 females, n =125. Tumor distribution No. Grade Stage Treatment Current PPIs G1 G2 G3 Local Distant Untreated Current SSAs Gastric 3 0 1 2 3 0 3 0 0 Duodenum 1 1 0 0

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Dong Cen Key Laboratory of Laparoscopic Technology of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Hui Liu Key Laboratory of Laparoscopic Technology of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Zhe Wan Key Laboratory of Laparoscopic Technology of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Zhongjie Lin Key Laboratory of Laparoscopic Technology of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Yanting Wang Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA

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Junjie Xu Key Laboratory of Laparoscopic Technology of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Yuelong Liang Key Laboratory of Laparoscopic Technology of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

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that the 1-, 2-, 3- and 4-year survival rates were 43–45, 30–33, 28–31, and 22–26%, respectively ( 7 ). In a study of biliary neuroendocrine neoplasms, the median survival of GB-NEN patients was 7.9 months and only grade 3 tumors, according to the 2010

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R C S van Adrichem
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L J Hofland
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R A Feelders
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M C De Martino
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P M van Koetsveld
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C H J van Eijck Department of Internal Medicine, Department of Surgery, Department of Pathology, Sector of Endocrinology, Erasmus MC, ‘s Gravendijkwal 230, Room D-430, 3015 CE Rotterdam, The Netherlands

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R R de Krijger Department of Internal Medicine, Department of Surgery, Department of Pathology, Sector of Endocrinology, Erasmus MC, ‘s Gravendijkwal 230, Room D-430, 3015 CE Rotterdam, The Netherlands

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D M Sprij-Mooij
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J A M J L Janssen
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W W de Herder
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studies have shown a significant shorter survival in Grade 3 GEP NET patients (Ki-67 index >20%) (24, 25) . A possible explanation for our discrepant results could be the very small sample size of these heterogeneous tumor entities and the short follow

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