Clinical features of pseudocirrhosis in metastatic breast cancer

• Published in: Breast cancer research and treatment 2019-09, Vol.177 (2), p.409-417
• Main Authors: Oliai, Caspian, Douek, Michael L., Rhoane, Caelainn, Bhutada, Abhishek, Ge, Phillip S., Runyon, Bruce A., Wang, Xiaoyan, Hurvitz, Sara A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ascites; Biomarkers, Tumor; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Cancer research; Care and treatment; Cirrhosis; Clinical Trial; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; Comparative analysis; Computed tomography; Development and progression; Diagnosis, Differential; Disease susceptibility; Etiology; Female; Follow-Up Studies; Humans; Hypertension; Kaplan-Meier Estimate; Liver; Liver cirrhosis; Liver Cirrhosis - diagnosis; Liver Cirrhosis - etiology; Liver Neoplasms - diagnosis; Liver Neoplasms - secondary; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Oncology; Phenotype; Prognosis; Proportional Hazards Models; Radiography; Risk factors; Splenomegaly; Survival; Tomography, X-Ray Computed; Young Adult
• ISSN: 0167-6806; 1573-7217; 1573-7217
• DOI: 10.1007/s10549-019-05311-y

Purpose Pseudocirrhosis has been demonstrated to mimic cirrhosis radiographically, but studies evaluating the pathophysiology and clinical features are lacking. To better understand the incidence, risk factors, clinical course, and etiology of pseudocirrhosis, we performed a retrospective analysis of consecutively treated patients with metastatic breast cancer (MBC). Methods Of 374 patients treated for MBC from 2006 to 2012, 199 had imaging available for review. One radiologist evaluated computed tomography scans for evidence of pseudocirrhosis. Features of groups with and without pseudocirrhosis were compared by Kaplan–Meier product-limit survival estimates and log-rank tests. Wilcoxon Rank-Sum testing evaluated if patients more heavily treated were more likely to develop pseudocirrhosis. Univariate and multivariate Cox proportional hazard models investigated factors associated with mortality. Results Pseudocirrhosis developed in 37 of 199 patients (19%). Of the patients with liver metastases, 55% developed pseudocirrhosis. Liver metastases were demonstrated in 100% of patients with pseudocirrhosis. Survival in the subset with liver metastases favored those without pseudocirrhosis, 189 versus 69 months ( p  = 0.01). The number of systemic regimens received were higher in patients with pseudocirrhosis ( p  = 0.01). Ascites was demonstrated in 68%, portal hypertension in 11%, and splenomegaly in 8% of patients with pseudocirrhosis. Conclusions Pseudocirrhosis does not occur in the absence of liver metastases, can manifest as hepatic decompensation, and appears to be associated with poorer survival amongst patients with hepatic metastases. Higher cumulative exposure to systemic therapy may be causative, instead of the previously held belief of pseudocirrhosis as an adverse effect of a particular systemic agent/class.