Recent advances in the management of pancreatic neuroendocrine tumors: From diagnosis, treatment to biology.

Pancreatic neuroendocrine tumors (PNETs) are relatively rare and highly heterogeneous tumors. Early diagnosis is a critical step in improving patient prognosis, but there is still a lack of circulating biomarkers with both high specificity and high sensitivity. The development of liquid biopsy technologies (such as CTCs and NETest) has opened new avenues for the early diagnosis of PNETs. Considerable heterogeneity among PNETs represents a major challenge to their effective clinical management. Radiomics, however, has demonstrated significant potential in predicting the malignant behavior of these tumors. For PNETs patients after radical resection, accurate postoperative risk stratification is a key basis for formulating individualized follow-up strategies and selecting adjuvant therapies. Molecular feature-based classification systems will be a major research focus in this field in the future. In the treatment of advanced PNETs, therapeutic strategies have become increasingly diverse. Advances in targeted therapy and immunotherapy have expanded the range of available treatment options for PNETs. However, numerous challenges remain, including limited efficacy, susceptibility to drug resistance, and the lack of standardized treatment sequences. Moreover, in response to these clinical difficulties, significant progress has been made in developing preclinical models that simulate the development and progression of PNETs. Therefore, this review systematically summarized the latest research advances in the diagnosis, treatment, and research models of PNETs.