Clinical features of pseudocirrhosis in metastatic breast cancer

Abstract

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.

Keywords: Breast cancer; Cirrhosis; Liver injury; Pseudocirrhosis.

Figure 1:

Kaplan-Meier plot of overall survival by pseudocirrhosis status.

Figure 2:

Kaplan-Meier plot of overall survival by pseudocirrhosis status in pts with liver metastases.

Figure 3:

Liver images of a single patient over time. From liver metastases to the development of pseudocirrhosis, with subsequent progression of pseudocirrhosis characterized as diffuse nodularity. A: 4/23/12: Axial Fat-Suppressed T2W MR images, demonstrating diffuse tumor infiltration, predominating in the left lobe of the liver (hypointense regions, arrows). B: 5/3/12: Non-contrast CT showing diffusely heterogeneous liver, compatible with diffuse tumor infiltration. C: 7/22/14: Contrast-enhanced T1W MR demonstrating smaller liver with macronodular change. Increasing splenic size. D: 3/18/16: CT with contrast. Progressive decrease in size and increase in nodularity of the liver. Increasing ascites and enlarging portosystemic varices (arrow).

Figure 4:

Liver images of a single patient over time. Normal liver with subsequent progression to pseudocirrhosis A: 8/14/09; smooth surface contour. B: 1/3/11 areas of capsular retraction (arrows) and generalized more fine nodularity of liver surface contour. New ascites*