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IntroductionPancreatic neuroendocrine tumors (PanNETs) have shown an increasing incidence, yet population-based studies examining the clinical characteristics and cancer-specific survival (CSS) specifically in adolescents and young adults (AYA) (aged 13-39 years) remain scarce.MethodsThis population-based, retrospective cohort study identified all patients diagnosed with PanNETs through the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was adopted to reduce selection bias. Kaplan-Meier analyses and Cox proportional hazards models were used to evaluate the impact of demographic and clinical variables on CSS. Temporal trends in incidence by age group were also assessed over the study period.ResultsA total of 4408 patients were included, with 338 in the AYA group and 4,070 in the older adult (OA) group (aged ≥ 40 years). Compared to the OA group, the AYA group had more female patients, earlier clinical staging, lower distant metastasis rates, and higher surgical treatment rates (P < 0.05). The AYA group exhibited better CSS (P=0.005). After PSM, the AYA group and the OA group had comparable CSS (P=0.261). Multivariate Cox regression analysis identified N stage and surgery as independent risk factors for CSS in the AYA group.ConclusionsIn this study, distinct clinical characteristics of AYA patients with PanNETs were identified compared with older adults. In this observational analysis, after PSM, CSS rates were similar between the two age groups, despite baseline differences before matching. The rising incidence of PanNETs in AYA individuals suggests a need for continued surveillance and personalized management in this young population.