Objective:Neuroendocrine neoplasms (NENs) are relatively rare and heterogeneous malignancies with two major subtypes:low-grade neuroendocrine tumor (NET) and high-grade neuroendocrine carcinoma (NEC).Comprehensive molecular characterization of NENs is needed to refine our understanding of the biological underpinnings of different NEN subtypes and to predict disease progression more accurately.Methods:We performed whole-exome sequencing (WES) of NEN samples from 49 patients (25 NETs and 24 NECs) arising from the stomach,intestines or lung.Clinicopathologic features were assessed and associated with molecular events.Results:NENs generally harbor a low mutation burden,with TP53 being the top mutated gene found in 31％ of patients.Consistent with other studies,p53 signaling pathway dysfunction is significantly enriched in NECs compared to NETs (P＜0.01).Other than TP53,tissue type-specific mutation profiles of NENs were observed in our cohort compared to those reported in pancreatic NETs.Importantly,we observed significant genomic instability,with increased copy number alterations observed across the NEN genome,which was more profound in NECs and independently correlated with poor overall survival (OS) (P＜0.001).NECs could be further stratified into two molecular subtypes based on OS (P＜0.001) and the chromosomal instability score (CIS).Interestingly,we discovered that the gain of whole chromosome 5 occurred at the early stage of NEN development,followed by the loss of 5q exclusively in NECs (P＜0.001).Conclusions:These findings provide novel insights into the molecular characteristics of NENs and highlight the association of genomic stability with clinical outcomes.