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Clinical features of pseudocirrhosis in metastatic breast cancer

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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.

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Funding

There was no sponsor that funded this study. SH receives support from NCI/NIH CA016042 and the Marni Levine Memorial Research Award.

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Authors and Affiliations

  1. Department of Medicine, Division of Hematology-Oncology, University of California, Los Angeles, 10945 Le Conte Ave, PVUB Suite 3360, Los Angeles, CA, 90095, USA

    Caspian Oliai, Caelainn Rhoane & Sara A. Hurvitz

  2. Department of Radiology, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA

    Michael L. Douek & Abhishek Bhutada

  3. Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77004, USA

    Phillip S. Ge

  4. Department of Gastroenterology & Hepatology, University of New Mexico, Albuquerque, NM, 87106, USA

    Bruce A. Runyon

  5. Department of Biostatistics, UCLA, 911 Broxton Ave., 3rd Floor, Los Angeles, CA, 90095, USA

    Xiaoyan Wang

Authors
  1. Caspian Oliai
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  2. Michael L. Douek
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  3. Caelainn Rhoane
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  4. Abhishek Bhutada
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  5. Phillip S. Ge
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  6. Bruce A. Runyon
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  7. Xiaoyan Wang
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  8. Sara A. Hurvitz
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Corresponding author

Correspondence to Sara A. Hurvitz.

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Conflict of interest

SH receives research funding paid to UCLA by Ambrx, Amgen, Bayer, Boehringer Ingelheim, Biomarin, Cascadian, Daiichi Sankyo, Dignitana, Genentech, GSK, Lilly, Macrogenics, Medivation, Merrimack, Novartis, OBI Pharma, Pfizer, Pieris, PUMA, Roche, and Seattle Genetics. SH has had travel support from Lilly, Novartis, and OBI Pharma. The other authors declare that they have no conflicts of interest.

Informed consent

This retrospective analysis was approved by the Institutional Review Board of the University of California, Los Angeles, which determined that informed consent was exempt for a retrospective study.

Research involving human participants and/or animals

This is a declaration that all aspects of this study comply with the current laws of the United States. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Oliai, C., Douek, M.L., Rhoane, C. et al. Clinical features of pseudocirrhosis in metastatic breast cancer. Breast Cancer Res Treat 177, 409–417 (2019). https://doi.org/10.1007/s10549-019-05311-y

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  • DOI: https://doi.org/10.1007/s10549-019-05311-y

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