Chemotherapy over surgery: The dominant prognosticator in synchronous pancreatic cancer with liver metastases—A multi-center propensity score–matched analysis.

Abstract

e16403 Background: Patients with pancreatic ductal adenocarcinoma (PDAC) liver metastases have a poor prognosis, and the best treatment remains uncertain. While systemic chemotherapy is standard, the benefit of liver metastasis resection in oligometastatic patients lacks high-level evidence, with many studies affected by bias and mixed results. This study evaluates the effect of synchronous liver metastasis resection on overall survival, adjusted for confounders through multicentre, propensity score-matched analysis, and identifies independent prognostic factors. Methods: This retrospective multicenter study in seven Chinese centers enrolled patients with pancreatic cancer and liver metastases from January 2017 to July 2025. Patients were divided into complete liver lesion management and partial/untreated groups based on intervention extent. Propensity score matching used covariates like sex, tumor location, and metastasis burden, with oligometastasis defined as < 3 lesions without extrahepatic spread. The primary endpoint was overall survival. Kaplan- Meier and Cox regression analysis compared groups and identified prognostic factors. Results: After matching, 48 patients (24 in each group) formed a balanced cohort. No significant baseline differences were found. Median survival was 19 months in the complete management group and 25 months in the partial/untreated group, with no significant difference (HR = 1.07. 07, P = 0. 853). Univariate analysis showed preoperative neoadjuvant chemotherapy, higher BMI, and lower ALT levels were associated with better prognosis. Multivariate analysis confirmed preoperative neoadjuvant chemotherapy and higher BMI as independent favorable factors. Subgroup analysis indicated complete metastasis management did not improve survival among those responding to neoadjuvant chemotherapy. Conclusions: This study found that aggressive liver metastasis resection does not significantly prolong survival. Systemic therapy, especially neoadjuvant chemotherapy, and nutritional status (BMI) are stronger prognostic factors. The results suggest focus should be on systemic and health management rather than aggressive surgery, providing high- level evidence supporting' chemotherapy over surgery" in this setting.