本综述对治疗晚期、无功能、分化良好的胰腺神经内分泌肿瘤（panNET）的国际指南进行了全面的比较分析。 PanNET 在胰腺神经内分泌肿瘤中占很大比例，根据分化、分级和其他分子标记表现出不同的临床行为和预后。不同指南提出的不同治疗策略反映了各自不同的侧重点和区域考虑，例如ESMO指南对高级疾病管理的关注和ENETS指南文件的多学科方法。本综述考察了 ESMO、NCCN、ASCO、ENETS 和 NANETS 的最新指南，分析了不同临床情况下一线治疗和后续治疗途径的建议。这些建议存在显着差异，特别是在全身治疗的选择和顺序、肿瘤分级和 Ki-67 指数在治疗决策中的作用以及区域监管和临床实践的整合方面。该分析强调需要采用量身定制的方法来管理先进的 NF panNET，提倡灵活地应用指南来考虑个体患者的情况和不断变化的证据基础。这项工作强调了管理此类患者群体的复杂性以及多学科团队在优化治疗结果方面的关键作用。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

This review presents a comprehensive comparative analysis of international guidelines for managing advanced, non-functioning, well-differentiated pancreatic neuroendocrine tumors (panNETs). PanNETs, which represent a significant proportion of pancreatic neuroendocrine neoplasms, exhibit diverse clinical behaviors and prognoses based on differentiation, grading, and other molecular markers. The varying therapeutic strategies proposed by different guidelines reflect their distinct emphases and regional considerations, such as the ESMO guideline's focus on advanced disease management and the ENETS guidance paper's multidisciplinary approach. This review examines the most recent guidelines from ESMO, NCCN, ASCO, ENETS, and NANETS, analyzing the recommendations for first-line therapies and subsequent treatment pathways in different clinical scenarios. Significant variations are observed in the recommendations, particularly concerning the choice and sequence of systemic therapies, the role of tumor grading and the Ki-67 index in therapeutic decisions, and the integration of regional regulatory and clinical practices. The analysis highlights the need for a tailored approach to managing advanced NF panNETs, advocating for flexibility in applying guidelines to account for individual patient circumstances and the evolving evidence base. This work underscores the complexities of managing this patient population and the critical role of a multidisciplinary team in optimizing treatment outcomes.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.