Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are a varied group of tumors that originate from neuroendocrine cells found throughout the gastrointestinal tract. These tumors encompass a broad spectrum of biological behaviors, ranging from slow-growing, well-differentiated neuroendocrine tumors (GEP-NETs) to aggressive and poorly differentiated neuroendocrine carcinomas (GEP-NECs), complicating their accurate classification and effective treatment. While advances in molecular research have refined our understanding of these tumors, their complexity, unpredictable progression, and differential response to therapies remain major clinical hurdles. A significant clinical challenge is the accurate grading and diagnosis of GEP-NENs, which is traditionally reliant on subjective methods. However, innovative technologies, such as artificial intelligence-based diagnostics, multi-omics approaches, and precision oncology, are now offering solutions for more precise and reliable classification. Meanwhile, emerging therapies aiming to activate the immune response or modify the tumor environment present promising avenues for improved outcomes. Realizing the full potential of these advances will require a thoughtful integration of molecular insights with standardized diagnostic practices and evolving therapeutic strategies, ensuring that progress in research meaningfully informs and enhances patient care across diverse clinical settings. This review discusses new advancements and explores future directions toward personalized and effective treatments for GEP-NENs.

Background: While previous studies have assessed patient reported quality of life (QOL) of various vestibular schwannoma (VS) treatment modalities, few studies have assessed QOL as related to the amount of residual tumor and need for retreatment in a large series of patients. Objective: To assess patient reported QOL outcomes following VS resection with a focus on extent of resection and retreatment. Methods: A retrospective chart review was performed using single-center institutional data of adult patients who underwent VS resection by the senior authors between 1989-2018 at Loyola University Medical Center. The Penn Acoustic Neuroma Quality of Life (PANQOL) survey was sent to all patients via postal mail. Results: Fifty-five percent of 367 total patients were female with a mean age of 61.6 years (SD 12.63). The mean period between surgery and PANQOL response was 11.4 years (IQR: 4.74-7.37). The median tumor size was 2 cm (IQR: 1.5-2.8). The mean total PANQOL score was 70 (SD 19). Patients who required retreatment reported lower overall scores (μdiff = -10.11, 95% CI: -19.48 to -0.74; p = 0.03) and face domain scores (μdiff = -20.34, 95% CI: -29.78 to -10.91; p < .001). There was no association between extent of resection and PANQOL scores in any domain. Conclusion: In an analysis of 367 patients who underwent microsurgical resection of VS, extent of resection did not affect PANQOL scores in contrast to previous reports in the literature, while the need for retreatment and facial function had a significant impact on patient-reported outcomes.

Background: Given the higher incidence of adrenocortical carcinoma in peri-menopausal women, this study investigates the associations between sex, age, and ACC prognosis. Methods: We analyzed the National Cancer Database (NCDB) for adult patients with ACC (n = 2384) from 2004 to 2022. Overall survival (OS) was the primary endpoint. Patients were stratified by sex and menopausal status (pre- and post-menopausal age of ≤45 and ≥55, respectively). Data from The Cancer Genome Atlas (TCGA) cohort (n = 92) were analyzed to examine clinical characteristics, genetics, transcriptomics, and methylation profiles of primary ACC samples by age group. Results: The analysis of the NCDB cohort revealed that younger men and pre-menopausal women had significantly longer OS compared to older groups. However, age was the only independent variable associated with OS. Using 50 years as the optimal age cutoff, we found no differences in clinical characteristics, rates of pathogenic driver mutations, methylation or gene expression profiles, or enriched molecular pathways in the TCGA ACC cohort by age group. Conclusions: While age ≥50 years is an independent factor associated with shorter OS in ACC, no differences in clinical characteristics or multi-omic profiles were observed by age. These findings suggest that age-related prognosis may be influenced by other factors such as microenvironmental changes or epigenetics.