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C R C Pieterman Section of Surgical Endocrinology, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

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S M Sadowski Endocrine Surgery, Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

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J E Maxwell Department of Surgical Oncology, University of Texas MD Anderson Cancer Center

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M H G Katz Department of Surgical Oncology, University of Texas MD Anderson Cancer Center

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K E Lines Academic Endocrine Unit, Radcliffe Department of Medicine, OCDEM, University of Oxford, Oxford, UK

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C M Heaphy Departments of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

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A Tirosh Neuroendocrine Tumors Service, Division of Endocrinology, Metabolism and Diabetes, The Chaim Sheba Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

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J E Blau Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA

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N D Perrier Section of Surgical Endocrinology, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

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M A Lewis Gastrointestinal Oncology, Intermountain Healthcare, Murray, Utah, USA
American Multiple Endocrine Neoplasia Support (AMENSupport), Maryville, Tennessee, USA

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J P Metzcar Association of Multiple Endocrine Neoplasia Disorders (AMEND), Bloomington, Indiana, USA
Departments of Intelligent Systems Engineering and Informatics, Indiana University, Bloomington, Indiana, USA

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D M Halperin Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

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R V Thakker Academic Endocrine Unit, Radcliffe Department of Medicine, OCDEM, University of Oxford, Oxford, UK

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G D Valk Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

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,000 ( Chandrasekharappa et al. 1997 ). By the age of 80 more than 80% of the patients will have developed a duodenopancreatic NET ( de Laat et al. 2016 ) and multifocality is common. Non-functional pancreatic NETs (nf-PanNETs) are the most common type of PanNET in

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Hiroki Ueda Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Yoshimitsu Akiyama Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Shu Shimada Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Kaoru Mogushi Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Misaki Serizawa Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Satoshi Matsumura Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Yusuke Mitsunori Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Arihiro Aihara Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Daisuke Ban Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Takanori Ochiai Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Atsushi Kudo Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Minoru Tanabe Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Shinji Tanaka Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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Pancreatic neuroendocrine tumors (PanNETs) have considerable malignant potential. Frequent somatic mutations and loss of DAXX protein expression have been found in PanNETs. DAXX is known as a transcriptional repressor; however, molecular functions underlying DAXX loss remain unclear in PanNETs. We evaluated DAXX expression by immunohistochemistry in 44 PanNETs. DAXX-knockdown (KD) and -knockout (KO) PanNET cells were analyzed for in vitro and vivo. The target genes were screened by microarray and chromatin immunoprecipitation (ChIP) assays for DAXX, histone H3.3 and H3K9me3 complex. In clinicopathological features, low DAXX expression was significantly correlated with nonfunctional tumors, higher Ki-67 index and WHO grade. Microarray and ChIP assays of DAXX-KD/KO identified 12 genes as the direct targets of DAXX transcriptional repressor. Among them, expression of five genes including STC2 was suppressed by DAXX/H3.3/H3K9me3 pathway. DAXX-KD/KO cells enhanced sphere forming activity, but its effect was suppressed by knockdown of STC2. In xenograft models, tumorigenicity and tumor vessel density were significantly increased in DAXX-KO cells with high expression of STC2. Clinically, higher recurrence rate was recognized in PanNETs with low expression of DAXX and high expression of STC2 than others (P = 0.018). Our data suggest that DAXX plays as a tumor suppressor and DAXX/H3.3 complex suppresses target genes by promoting H3K9me3 in PanNETs. Combination of DAXX loss and its target gene STC2 overexpression might be effective biomarkers and therapeutic candidates.

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Olga Lakiza Endocrine and Neuroendocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA

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Julian Lutze Committee on Cancer Biology, University of Chicago, Chicago, Illinois, USA

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Alyx Vogle Endocrine and Neuroendocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA

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Jelani Williams Endocrine and Neuroendocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA

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Abde Abukdheir Division of Hematology, Oncology, and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA

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Paul Miller Endocrine and Neuroendocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA

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Chih-Yi ‘Andy’ Liao Division of Hematology and Oncology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA

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Sean P Pitroda Department of Radiation Oncology and Cellular Biology, University of Chicago, Chicago, Illinois, USA

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Carlos Martinez Department of Radiation Oncology and Cellular Biology, University of Chicago, Chicago, Illinois, USA

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Andrea Olivas Department of Pathology, University of Chicago, Chicago, Illinois, USA

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Namrata Setia Department of Pathology, University of Chicago, Chicago, Illinois, USA

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Stephen J Kron Committee on Cancer Biology, University of Chicago, Chicago, Illinois, USA
Department of Molecular Genetics and Cell Biology, University of Chicago, Chicago, Illinois, USA

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Ralph R Weichselbaum Department of Radiation Oncology and Cellular Biology, University of Chicago, Chicago, Illinois, USA
Ludwig Center for Metastasis Research, University of Chicago, Chicago, Illinois, USA

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Xavier M Keutgen Endocrine and Neuroendocrine Surgery Research Program, Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA

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Somatic MEN1 mutations occur in up to 50% of pancreatic neuroendocrine tumors (PanNETs). Clinical studies have shown that radiation therapy (IR) is effective in a subset of PanNETs, but it remains unclear why some patients respond better to IR than others. Herein, we study whether MEN1 loss of function increases radiosensitivity of PanNETs and determine its effect on DNA double-strand break (DSB) repair. After creating a MEN1 knockout PanNET cell line, we confirmed reduced DSB repair capacity in MEN1-deficient cells and linked these findings to a defect in homologous recombination, as well as reduced BRCA2 expression levels. Consistent with this model, we found that MEN1 mutant cells displayed increased sensitivity to the highly trapping poly (ADP-ribose) polymerase (PARP) 1 inhibitor talazoparib in vitro. Our results suggest that combining IR with PARP inhibition may be beneficial in patients with PanNETs and MEN1 loss of function.

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Nele Garbrecht
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Martin Anlauf
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Anja Schmitt Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Tobias Henopp
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Bence Sipos
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Andreas Raffel Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Claus F Eisenberger Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Wolfram T Knoefel Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Marianne Pavel Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Christian Fottner Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Thomas J Musholt Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Anja Rinke Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Rudolf Arnold Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Uta Berndt Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Ursula Plöckinger Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Bertram Wiedenmann Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Holger Moch Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Philipp U Heitz Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Paul Komminoth Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany
Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Aurel Perren Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany
Department of Pathology, Department of Pathology, Department of General, Department of Gastroenterology and Endocrinology, Department of Endocrinology, Department of General and Abdominal Surgery, Department of Gastroenterology and Endocrinology, Department of Hepatology and Gastroenterology, Department of Pathology, Institute of Pathology, University of Kiel, Michaelisstr. 11, 24105 Kiel, Germany

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Günter Klöppel
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functional activity is therefore based on reports of single or small series of patients and reviews ( Hamid et al . 1986 , Tomic & Warner 1996 , Soga & Yakuwa 1999 ). In this study, we analyzed a series of 623 resected duodenal and pancreatic NETs by

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Nicole Panarelli Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA

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Kathrin Tyryshkin Laboratory of Translational RNA Biology, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada

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Justin Jong Mun Wong Laboratory of Translational RNA Biology, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada

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Adrianna Majewski Laboratory of Translational RNA Biology, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada

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Xiaojing Yang Laboratory of Translational RNA Biology, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada

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Theresa Scognamiglio Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA

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Michelle Kang Kim Center for Carcinoid and Neuroendocrine Tumors of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA

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Kimberly Bogardus HHMI, Laboratory of RNA Molecular Biology, The Rockefeller University, New York, New York, USA

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Thomas Tuschl HHMI, Laboratory of RNA Molecular Biology, The Rockefeller University, New York, New York, USA

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Yao-Tseng Chen Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA

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Neil Renwick Laboratory of Translational RNA Biology, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
HHMI, Laboratory of RNA Molecular Biology, The Rockefeller University, New York, New York, USA

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ileal and appendiceal NETs (comparison B) and rectal and pancreatic NETs (comparison C). We also compared miRNA expression differences between NETs from each anatomic site of origin (i.e. pancreas, ileum, appendix or rectum) and the remaining three GEP

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Elke Tatjana Aristizabal Prada Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Vera Heinzle Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Thomas Knösel Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Institute of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany

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Svenja Nölting Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Gerald Spöttl Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Julian Maurer Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Christine Spitzweg Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Martin Angele Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Nina Schmidt Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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Felix Beuschlein Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zurich, Switzerland

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Günter K Stalla Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany

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Rainer Blaser Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany

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Klaus A Kuhn Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany

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Christoph J Auernhammer Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Campus Grosshadern, Munich, Germany
Department of Internal Medicine 2, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany
Department of Internal Medicine 4, University-Hospital, Klinikum der Universität München, Ludwig-Maximilians-University of Munich, Munich, Germany

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/33 (33%) of all pNETs ( Table 2 ). These data demonstrate a high prevalence of Trk receptor expression in pancreatic NETs. Therefore, immunohistochemical or molecular screening for Trk expression in pNETs might be useful as a predictive marker to select

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Maria Chiara Zatelli Section of Endocrinology and Internal Medicine, Neuroendocrine Tumours Unit, Endocrinology Unit, Department of Clinical Medicine and Surgery, Thyroid and Parathyroid Surgery Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona – Ferrara, Italy

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Giuseppe Fanciulli Section of Endocrinology and Internal Medicine, Neuroendocrine Tumours Unit, Endocrinology Unit, Department of Clinical Medicine and Surgery, Thyroid and Parathyroid Surgery Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona – Ferrara, Italy

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Pasqualino Malandrino Section of Endocrinology and Internal Medicine, Neuroendocrine Tumours Unit, Endocrinology Unit, Department of Clinical Medicine and Surgery, Thyroid and Parathyroid Surgery Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona – Ferrara, Italy

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Valeria Ramundo Section of Endocrinology and Internal Medicine, Neuroendocrine Tumours Unit, Endocrinology Unit, Department of Clinical Medicine and Surgery, Thyroid and Parathyroid Surgery Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona – Ferrara, Italy

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Antongiulio Faggiano Section of Endocrinology and Internal Medicine, Neuroendocrine Tumours Unit, Endocrinology Unit, Department of Clinical Medicine and Surgery, Thyroid and Parathyroid Surgery Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona – Ferrara, Italy

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Annamaria Colao Section of Endocrinology and Internal Medicine, Neuroendocrine Tumours Unit, Endocrinology Unit, Department of Clinical Medicine and Surgery, Thyroid and Parathyroid Surgery Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona – Ferrara, Italy

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on behalf of NIKE Group
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increased phospho -AKT and decreased phospho -mTOR expression. Spada et al . (2014) observed that among 36 patients with metastatic gastro-entero-pancreatic NETs treated with everolimus 10 mg once daily, patients with Ki-67 ≤20% (30/36) displayed a

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Louis de Mestier Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France
Centre of Research on Inflammation, INSERM U1149, Paris, France

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Anne Couvelard Centre of Research on Inflammation, INSERM U1149, Paris, France
Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospitals (APHP), and Université de Paris, Clichy/Paris, France

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Anela Blazevic Division Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus Medical Center, Rotterdam, The Netherlands

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Olivia Hentic Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France

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Wouter W de Herder Division Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus Medical Center, Rotterdam, The Netherlands

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Vinciane Rebours Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France
Centre of Research on Inflammation, INSERM U1149, Paris, France

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Valérie Paradis Centre of Research on Inflammation, INSERM U1149, Paris, France
Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospitals (APHP), and Université de Paris, Clichy/Paris, France

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Philippe Ruszniewski Department of Gastroenterology-Pancreatology, ENETS Centre of Excellence, Beaujon University Hospital (APHP), and Université de Paris, Clichy, France
Centre of Research on Inflammation, INSERM U1149, Paris, France

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Leo J Hofland Division Endocrinology, Department of Internal Medicine, ENETS Centre of Excellence, Erasmus Medical Center, Rotterdam, The Netherlands

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Jérôme Cros Centre of Research on Inflammation, INSERM U1149, Paris, France
Department of Pathology, ENETS Centre of Excellence, Bichat/Beaujon University Hospitals (APHP), and Université de Paris, Clichy/Paris, France

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tumor burden and/or high Ki67 index), or in a neoadjuvant setting aiming to obtain tumor shrinkage ( Frilling et al. 2014 , Pavel et al. 2016 ). Of note, chemotherapy is especially relevant in pancreatic NETs (PanNETs), which are more chemo

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Maria Chiara Zatelli
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Mirella Torta
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Antonette Leon
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Massimo Gion
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Gianfranco Delle Fave
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Luigi Dogliotti
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Ettore C degli Uberti
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for pancreatic NETs, with the chosen cutoff levels for both IRMA and ELISA assays, PPV was 84% and NPV was 78%, with 90% specificity and 68% sensitivity. On the other hand, PPV and NPV for stomach were 22 and 79% with the ELISA assay. Table

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Anna Karpathakis University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK
University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK

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Martyn Caplin University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK

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Christina Thirlwell University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK
University College London Cancer Institute, Neuroendocrine Tumour Unit, Paul O'Gorman Building, Huntley Street, London WC1E 6BT, UK

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and discuss recent advances in the elucidation of the biological pathways involved in the development of pancreatic NETs (pNETs), focusing on the use and suggested scheduling of sunitinib and everolimus. Pathogenesis NETs are ‘rare’ tumours with a

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