Impact of metabolic dysfunction-associated steatotic liver disease on liver metastasis and survival in pancreatic cancer

BACKGROUND Pancreatic cancer frequently metastasizes to the liver, and thereby confers high mortality risk. AIM To investigated the effect of metabolic dysfunction-associated steatotic liver disease (MASLD) on liver metastasis and survival outcomes in patients with pancreatic cancer, as the increasing incidence of MASLD. METHODS We retrospectively analyzed data from 2123 patients who were diagnosed with pancreatic cancer between 2006 and 2021. MASLD was diagnosed based on a hepatic steatosis index (HSI) > 30. RESULTS In the study population, which predominantly comprised males, the median age was 66 years (n = 1118, 52.6%). Patients with liver metastasis at baseline (n = 540, 25.4%) had larger tumors (median, 41 mm vs 35 mm) and higher carbohydrate antigen (CA) 19-9 levels (median 975.0 U/mL vs 206.2 U/mL; all P < 0.001). During the follow-up period (median 9.7 months), 502 (23.6%) patients were diagnosed with new liver metastases, and 819 (38.6%) died. MASLD did not significantly correlate with liver metastasis at diagnosis or new liver metastases (all P > 0.05). In contrast, younger age [hazard ratio (HR) = 0.985, 95% confidence interval (CI): 0.974-0.997], increased tumor size (HR = 1.008, 95%CI: 1.001-1.016), and elevated CA19-9 levels (HR = 1.662, 95%CI: 1.279-2.160) were significantly associated with new liver metastases during the follow-up (all P < 0.05). Although MASLD appeared to be associated with reduced mortality in the univariate analysis (HR = 0.807, P = 0.011), this association was not sustained in the multivariate analysis (P > 0.05). CONCLUSION Thus, HSI-defined MASLD does not directly influence liver metastasis or survival in patients with pancreatic cancer.