Publication Name	World Journal of Gastroenterology
Manuscript ID	119356
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Opinion Review
Article Title	Is metabolic dysfunction-associated steatotic liver disease truly irrelevant? Unmasking the heterogeneity and confounders in pancreatic cancer outcomes
Manuscript Source	Invited Manuscript
All Author List	Zhe-Kun Xiong, Yu-Zi Jiang, Yan-Hua Lin, Jian-Dong Cao, Tao-Ying Deng and Yi-Yuan Zheng
Funding Agency and Grant Number
Corresponding Author	Yi-Yuan Zheng, PhD, Laboratory Center, Department of Hepatopathy, Shanghai Municipal Hospital of Traditional Chinese Medicine, No. 274 Zhijiang Middle Road, Shanghai 200071, China. iceroser@126.com
Key Words	Metabolic dysfunction-associated liver disease; Pancreatic cancer; Metastasis; Statistical biases; Phenotypic heterogeneity; Biological plausibility
Core Tip	This article challenges the conclusion that MASLD is irrelevant to pancreatic cancer outcomes. We argue that the reported lack of association stems from the use of noninvasive surrogates that fail to capture the complexity of metabolic inflammation in cachectic patients. By ignoring the heterogeneity of MASLD and the statistical impact of competing risks, current analyses likely underestimate the pro-metastatic potential of the fibrotic liver niche. Furthermore, by contrasting these limitations with mechanistic evidence of a pre-metastatic niche, we emphasize that statistical absence of correlation does not equal biological absence of causation, advocating for fibrosis-focused future research.
Citation	Xiong ZK, Jiang YZ, Lin YH, Cao JD, Deng TY, Zheng YY. Is metabolic dysfunction-associated steatotic liver disease truly irrelevant? Unmasking the heterogeneity and confounders in pancreatic cancer outcomes. World J Gastroenterol 2026; In press

Received	2026-01-26 01:02
Peer-Review Started	2026-01-26 01:03
First Decision by Editorial Office Director	2026-02-13 08:14
Return for Revision	2026-02-13 08:14
Revised	2026-02-25 17:31
Publication Fee Transferred
Second Decision by Editor	2026-03-24 02:50
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-03-24 10:01
Articles in Press	2026-03-24 10:01
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1007-9327 (print) and 2219-2840 (online)
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