AbstractBackgroundThe study aims to evaluate the performance of three advanced machine learning algorithms and a traditional Cox proportional hazard (CoxPH) model in predicting the overall survival (OS) of patients with pancreatic neuroendocrine neoplasms (PNENs).MethodThe clinicopathological dataset obtained from the Surveillance, Epidemiology, and End Results database was randomly assigned to the training set and testing set at a ratio of 7:3. The concordance index (C‐index) and integrated Brier score (IBS) were used to compare the predictive performance of the models. The accuracy of the model in predicting the 5‐year and 10‐year survival rates was compared using the receiver operating characteristic curve, decision curve analysis (DCA) and calibration curve.ResultsThis study included 3239 patients with PNENs in total. The DeepSurv model had the highestC‐index of 0.7882 in the testing set and training set and the lowest IBS of 0.1278 in the testing set compared with the CoxPH, neural multitask logistic and random survival forest models (C‐index = 0.7501, 0.7616, and 0.7612, respectively; IBS = 0.1397, 0.1418, and 0.1432, respectively). Moreover, the DeepSurv model had the highest accuracy in predicting 5‐ and 10‐year OS rates (area under the curve: 0.87 and 0.90). DCA showed that the DeepSurv model had high potential for clinical decisions in 5‐ and 10‐year OS models. Finally, we developed an online application based on the DeepSurv model for clinical use (https://whuh‐ml‐neuroendocrinetumor‐app‐predict‐oyw5km.streamlit.app/).ConclusionsAll four models analyzed above can predict the prognosis of PNENs well, among which the DeepSurv model has the best prediction performance.