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Impact of metabolic dysfunction-associated steatotic liver disease on liver metastasis and survival in pancreatic cancer
Hee Seung Lee, Seung Up Kim, Seung Woo Park, Seungmin Bang, Jeong Youp Park, Moon Jae Chung, Jung Hyun Jo, Galam Leem, Jeehoon Kim, Hyungjin Rhee, Hye Yeon Chon
Hye Yeon Chon, Seung Up Kim, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, South Korea
Hye Yeon Chon, Division of Gastroenterology and Hepatology, Yongin Severance Hospital, Yongin 16995, South Korea
Hyungjin Rhee, Department of Radiology, Yonsei University College of Medicine, Seoul 03722, South Korea
Jeehoon Kim, Galam Leem, Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Hee Seung Lee, Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, South Korea
Jeehoon Kim, Galam Leem, Moon Jae Chung, Jeong Youp Park, Seungmin Bang, Seung Woo Park, Hee Seung Lee, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, South Korea
Jung Hyun Jo, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 07322, South Korea
Seung Up Kim, Yonsei Liver Center, Severance Hospital, Seoul 03722, South Korea
Co-corresponding authors: Seung Up Kim and Hee Seung Lee.
Author contributions: Chon HY contributed to data acquisition, statistical analysis, interpretation and manuscript drafting; Lee HS, Kim SU contributed to study concept and design, manuscript drafting, and critical revision; Kim J, Leem G, Jo JH, Chung MJ, Park JY, Bang S, Park SW contributed to study supervision; Rhee H contributed to data acquisition, interpretation and critical manuscript revision; all authors have read and approve the final manuscript.
Supported by the National Research Foundation of Korea (NRF) and Funded by the Korean Government (MIST), No. RS-2024-00342475 and No. RS-2024-00335625; and the Korea Health Technology RD Project Through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health and Welfare, Republic of Korea, No. RS-2025-25458830 and No. RS-2025-25459146.
Institutional review board statement: The study protocol was reviewed and approved by the institutional review board of the healthcare center (No. 4-2024-1444).
Informed consent statement: As this retrospective study involved the analysis of de-identified patient data, the need for informed consent from individual patients was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The data that support the findings of this study are not openly available and are available from the corresponding author upon reasonable request.
Corresponding author: Hee Seung Lee, MD, Professor, Division of Gastroenterology, De
partment of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
lhs6865@yuhs.ac
Received: October 20, 2025
Revised: November 14, 2025
Accepted: January 12, 2026
Published online: March 21, 2026
Processing time: 149 Days and 22.5 Hours
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.
Core Tip: Pancreatic cancer frequently spreads to the liver, contributing to its high mortality. With the rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), its potential impact on cancer outcomes remains uncertain. In this large cohort study of 2123 patients with pancreatic cancer, MASLD-defined by a hepatic steatosis index, was not associated with liver metastasis at diagnosis, new liver metastasis during follow-up or overall survival after adjustment for other risk factors. These findings suggest that MASLD does not significantly influence the metastatic pattern or prognosis in patients with pancreatic cancer.
