Pseudocirrhosis and portal hypertension in patients with metastatic cancers: a systematic review and meta-analysis

Abstract

Pseudocirrhosis is a clinical and radiological entity mimicking liver cirrhosis in patients without a history of chronic liver disease. We performed a systematic review and meta-analysis of the current literature to evaluate the state-of-the-art and investigate the epidemiology and clinical features of pseudocirrhosis. We searched PubMed, Web of Science and Scopus for literature published until February 28, 2022. We included in the final analysis 62 articles (N = 389 patients): 51 case reports (N = 64 patients), 5 case series (N = 35 patients) and 6 observational studies (N = 290 patients). About 80% of patients included in the case reports and case series had breast cancer. Most patients had at least one clinical sign of portal hypertension and ascites was the most common clinical manifestation of portal hypertension. The median time from pseudocirrhosis to death was 2 months (IQR 1-7 months). Alkylating agents and antimitotics were the most common classes of anticancer drugs reported in our study population. Notably, about 70% of patients received three or more anticancer drugs. Finally, pseudocirrhosis is a condition that occurs in patients with hepatic metastases and may have a negative impact on survival and clinical management of patients because of the potential development of portal hypertension and its complications.

Figure 1

PRISMA flowchart of selected studies.

Figure 2

Prevalence of ascites in patients with pseudocirrhosis. Forest plot of overall pooled prevalence of ascites (random effect model); data from observational studies. 95%CI: 95% Confidence Intervals; ES: effect size; I²: heterogeneity.

Figure 3

Prevalence of splenomegaly in patients with pseudocirrhosis. Forest plot of overall pooled prevalence of splenomegaly (random effect model); data from observational studies. 95%CI: 95% Confidence Intervals; ES: effect size; I²: heterogeneity.

Figure 4

Prevalence of varices in patients with pseudocirrhosis. Forest plot of overall pooled prevalence of varices (random effect model); data from observational studies. 95%CI: 95% Confidence Intervals; ES: effect size; I²: heterogeneity.

Figure 5

Anticancer drugs in patients with pseudocirrhosis. Anticancer drugs reported in case reports and in case series. Values are expressed as frequencies.

Figure 6

Number of anticancer drugs used in patients in patients with pseudocirrhosis. Data from case reports and case series. Values are expressed as frequencies.