Li YL, Zhang DJ, Zhu YY, Wang CX, Liu Q. Reconsidering the role of metabolic dysfunction-associated steatotic liver disease in pancreatic cancer progression. World J Gastroenterol 2026; 32(25): 119116 [DOI: 10.3748/wjg.119116]
Corresponding Author of This Article
Chun-Xi Wang, MD, Doctor, Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Xinmin Street, Changchun 130000, Jilin Province, China. wangchunxi_2020@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Li YL, Zhang DJ, Zhu YY, Wang CX, Liu Q. Reconsidering the role of metabolic dysfunction-associated steatotic liver disease in pancreatic cancer progression. World J Gastroenterol 2026; 32(25): 119116 [DOI: 10.3748/wjg.119116]
World J Gastroenterol. Jul 7, 2026; 32(25): 119116 Published online Jul 7, 2026. doi: 10.3748/wjg.119116
Reconsidering the role of metabolic dysfunction-associated steatotic liver disease in pancreatic cancer progression
Yan-Ling Li, Dong-Jie Zhang, Ying-Ying Zhu, Chun-Xi Wang, Qing Liu
Yan-Ling Li, Department of Nephrology, The Second Hospital of Jilin University, Changchun 130021, Jilin Province, China
Dong-Jie Zhang, Department of Cardiovascular Medicine, The Second Hospital of Jilin University, Changchun 130021, Jilin Province, China
Ying-Ying Zhu, Department of Breast Surgery, The Second Hospital of Jilin University, Changchun 130021, Jilin Province, China
Chun-Xi Wang, Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Qing Liu, Department of Endocrinology and Metabolism, China-Japan Union Hospital of Jilin University, Changchun 130000, Jilin Province, China
Co-corresponding authors: Chun-Xi Wang and Qing Liu.
Author contributions: Wang CX and Liu Q conceived the article and provided overall academic supervision; Li YL conducted the literature synthesis and drafted the manuscript; Zhang DJ and Zhu YY contributed to critical review of the evidence and intellectual revisions; Wang CX and Liu Q critically revised and approved the final manuscript as co-corresponding authors; all authors approved the final manuscript.
AI contribution statement: ChatGPT was used solely for language polishing to improve the grammar, clarity, and readability of the manuscript. The scientific content, including the abstract, introduction, materials and methods, results, discussion, and conclusion, was entirely written by the authors and was not generated by AI. AI tools were not involved in the study design, data analysis, interpretation of results, or formulation of scientific conclusions. In addition, no figures, images, or graphical materials included in this manuscript were generated by AI.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Chun-Xi Wang, MD, Doctor, Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Xinmin Street, Changchun 130000, Jilin Province, China. wangchunxi_2020@126.com
Received: January 20, 2026 Revised: February 21, 2026 Accepted: March 19, 2026 Published online: July 7, 2026 Processing time: 162 Days and 9 Hours
Abstract
The liver is the most common site of metastasis in pancreatic cancer, and host metabolic conditions have increasingly been proposed as modifiers of tumor dissemination and survival. Metabolic dysfunction-associated steatotic liver disease (MASLD) has attracted particular attention because of its high prevalence and its documented effects on hepatic inflammation, lipid metabolism, and immune regulation. On this basis, it has been hypothesized that a steatotic liver may provide a permissive microenvironment for metastatic seeding. However, emerging large-scale real-world clinical evidence challenges this assumption. In a cohort of more than two thousand patients with pancreatic cancer, steatosis defined by the hepatic steatosis index was not independently associated with liver metastasis at diagnosis, the subsequent development of hepatic metastases, or overall survival. These findings suggest that, despite strong biological plausibility, metabolic liver disease may not represent a dominant driver of metastatic patterns or prognosis in pancreatic cancer. From a gastroenterology and oncology perspective, this discrepancy underscores the need to distinguish mechanistic hypotheses from clinically meaningful risk modifiers. Reframing MASLD as a background metabolic comorbidity rather than a key determinant of metastatic risk may help refine patient stratification, avoid overinterpretation of incidental hepatic steatosis in clinical practice, and redirect future research toward more actionable tumor-intrinsic and host-tumor interaction pathways.
Core Tip: Metabolic dysfunction-associated steatotic liver disease is biologically linked to hepatic inflammation and immune modulation, yet emerging real-world evidence indicates that it is not an independent determinant of liver metastasis or survival in pancreatic cancer. Clinically, metabolic dysfunction-associated steatotic liver disease should be interpreted as a contextual metabolic comorbidity rather than a decisive prognostic factor, avoiding overinterpretation of incidental hepatic steatosis in risk assessment.
