The incidence of pancreatic neuroendocrine neoplasms (NENs) is rising; whether this reflects a true increase in disease occurrence or improved detection remains uncertain. We conducted a retrospective, population‐based study using data from the Surveillance, Epidemiology, and End Results (SEER) Program (1975–2021) to examine temporal trends in the incidence of pancreatic NENs and assess whether changes reflect improved detection versus a true increase. Incidence trends were stratified by demographic and socioeconomic proxies of healthcare access, including income, residential setting, and race as recorded in SEER at the county level. We identified 16,253 cases of pancreatic NENs (44.6% women; median age 62 years). Incidence increased 7.75‐fold between 1975 and 2021, rising from 0.21 cases per 100,000 population in 1975 to 1.58 per 100,000 in 2021. Median tumour size at diagnosis decreased significantly, with an average annual reduction of 0.73 mm ( R ² = 0.765; p < 0.001). After adjustment, incidence increased more steeply among men, individuals aged 40–65 years and >65 years (vs. <40 years), those recorded as White (vs. Black and other races), individuals with higher income, and those residing in urban (vs. rural) counties. Incidence also rose more steeply for tumours located in the pancreatic tail, for grade 1 tumours (vs. grades 2 and 3), and for smaller tumours (vs. larger ones). The rising incidence of pancreatic NENs is probably explained by improved detection, particularly among populations with greater access to healthcare, rather than by a true increase in disease occurrence.

PD-1/PD-L1 inhibitors plus platinum-etoposide are standard first-line therapy for extensive-stage small-cell lung cancer (ES-SCLC), but the consistency of benefit across trials and potential PD-1 versus PD-L1 class differences remain debated. We conducted an updated systematic review and meta-analysis of phase III trials in untreated ES-SCLC. MEDLINE, Scopus, and Cochrane CENTRAL were searched through 11 February 2026 for phase III randomized trials comparing platinum-etoposide plus a PD-1/PD-L1 inhibitor versus platinum-etoposide alone. OS and PFS hazard ratios (HRs) were pooled using random-effects (REML). A pre-specified meta-regression tested PD-1 versus PD-L1 class effect (ratio of HRs). Safety endpoints were synthesized using risk ratios (RRs). RoB 2 and GRADE were applied. Six trials (n = 2,897) were included. Chemo-immunotherapy improved OS (HR 0.74, 95% CI 0.67-0.81; I² = 0%) and PFS (HR 0.68, 95% CI 0.58-0.78; I² = 65.6%). No statistically detectable difference between PD-1 and PD-L1 inhibitor classes was identified for OS (ratio of HRs 1.01, 95% CI 0.85-1.21; p = 0.89) or PFS (0.83, 0.64-1.09; p = 0.18). Grade ≥ 3 treatment-related adverse events were not increased (RR 1.01, 0.96-1.06), while immune-mediated adverse events were more frequent (RR 2.39, 1.61-3.54) with substantial heterogeneity. Certainty was high for OS, low for PFS, and moderate-to-very low for safety. Adding a PD-1/PD-L1 inhibitor to platinum-etoposide in first-line ES-SCLC provides a consistent overall survival benefit, with no statistically detectable differences between PD-1 and PD-L1 inhibitor classes. This finding should be interpreted as absence of detectable class-level divergence rather than pharmacologic equivalence.

Neuroendocrine neoplasms (NENs) of the lung are a biologically and clinically diverse group of tumors that includes well-differentiated typical and atypical carcinoids (LNETs), as well as poorly differentiated large-cell neuroendocrine carcinoma and small-cell lung cancer. Despite their relative rarity, the incidence of LNETs is increasing, primarily due to advancements in diagnostic techniques and heightened clinical awareness. While the current World Health Organization (WHO) classification offers a morphological basis for diagnosis and prognosis, particularly for extrapulmonary neuroendocrine neoplasms (ep-NENs), it has limitations in predicting the clinical behavior of pulmonary carcinoids. Recent evidence highlights the inadequacy of traditional criteria in fully capturing the biological complexity and clinical heterogeneity of these tumors. This review explores the evolving landscape of LNETs, focusing on well-differentiated forms and analyzing current classification systems, clinicopathological features, and the emerging role of novel prognostic and predictive biomarkers. Advances in histopathology and molecular profiling have begun to elucidate distinct molecular subsets within carcinoids, offering potential avenues for improved risk stratification and therapeutic decision-making. Although there are limited treatment options for advanced disease, new insights into tumor biology could facilitate the development of personalized therapeutic strategies and pave the way for future innovations in LNET management.

The incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) is increasing, but population registries seldom capture detailed clinical data. The Italian Association for Neuroendocrine Tumours (Itanet) established a nationwide prospective database to describe presentation, diagnostic pathways, management, and outcomes of newly diagnosed GEP-NENs in Italy. This multicentre prospective observational study enrolled 2138 consecutive patients with newly diagnosed GEP-NENs across 38 Italian centres (2019–2024). Clinical, pathological, imaging, and treatment data were prospectively collected and centrally validated. Descriptive and survival analyses were performed; Ki-67 was modelled as a continuous variable. Median age was 60.6 years, and 55.9% (1195/2138) were male. Tumours were well-differentiated NETs in 90.8% of patients (1942/2138), mainly of pancreatic (41.4%, 886/2138) or ileal (19.7%, 422/2138) origin. Median Ki-67 was 2%. An incidental diagnosis occurred in 58.6% (1254/2138) of cases. Among symptomatic patients, the mean diagnostic delay was 197 days (224 for pancreatic vs 184 for small bowel; p = 0.039). ⁶⁸Ga-DOTA-peptide PET showed higher diagnostic yield than CT or MRI in small-bowel primaries (93.7% vs 83.1% vs 67.4%), whereas performance was similar in pancreatic tumours. Data on first-line treatment were available for 2050 patients. Initial management included surgery in 36.4% (746/2050), watchful waiting in 19.7% (404/2050), endoscopic resection in 7.7% (158/2050). Overall, 30.6% (627/2050) of patients received systemic therapy, most commonly somatostatin analogues in 23.7% (487/2050). Over a median follow-up of 271 days (IQR 121–530), 62 deaths were observed (event rate 4.9%). Overall survival differed markedly according to metastatic status and tumour grade. Ki-67 was prognostic when modelled continuously (p < 0.001), and a 15% cutoff identified poorer outcomes. This nationwide prospective study delineates real-world diagnostic and therapeutic patterns of GEP-NENs in Italy, confirms Ki-67 as a continuous prognostic biomarker, and identifies a 15% threshold associated with worse survival, providing a benchmark for outcome assessment and future clinical research. None.