In the present work, Hackeng et al consolidated the prognostic relevance of DAXX and ATRX loss in PanNETs, using a multicentre collective including 561 patients with PanNET.6 In multivariate analysis including tumour grade, lymph vascular invasion, perineural invasion, tumour stage, regional lymph node metastasis, loss of DAXX/ATRX expression and the presence of ALT, both loss of DAXX/ATRX and ALT activation were found independent prognostic factors for relapse free survival (p<0.001 for both).6 This evidence concerns the gene ATRX and metastatic malignant neoplasm in the lymph nodes.