A new risk score for lymph node-negative pancreatic neuroendocrine tumors helps identify patients at risk for recurrence and guides postoperative surveillance.

• Recurrence rate for lymph node-negative patients was 10.6%, occurring at a median of 32.4 months post-surgery.
• Risk factors included male sex (2.2x), tumor size ≥3 cm (2.64x), grade 2 or higher (3.70x), and lymphovascular invasion (3.84x).
• The risk score’s performance was strong, with a c-statistic of 0.83 internally and 0.95 externally, stratifying patients into low (2.4%), moderate (9.0%), and high (27.7%) recurrence groups.

This tool supports tailored long-term surveillance strategies for higher-risk patients after surgery.