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Clinical characteristics and outcomes in patients with metastatic breast cancer and pseudocirrhosis: a single center retrospective cohort study

  • Epidemiology
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Abstract

Purpose

Pseudocirrhosis is a term used to describe changes in hepatic contour that mimic cirrhosis radiographically, but lack the classic pathologic features of cirrhosis. This radiographic finding is frequently found in patients with metastatic breast cancer (MBC), but the risk factors and clinical consequences are poorly understood.

Methods

In this retrospective study, we identified patients with MBC and pseudocirrhosis who were treated at a single center from 2002 to 2021. We used chart extraction and radiology review to determine demographic characteristics, treatment history, imaging features, and complications of pseudocirrhosis.

Results

120 patients with MBC and pseudocirrhosis were identified with the following BC subtypes: hormone receptor (HR) positive, HER2 negative (n = 99, 82.5%), HR+/HER2+ (n = 14, 11.7%), HR− /HER2+ (n = 3, 2.5%), and triple negative (TNBC; n = 4, 3.3%). All patients had liver metastases and 82.5% (n = 99) had > 15 liver lesions. Thirty-six patients (30%) presented with de novo metastatic disease. Median time from MBC diagnosis to pseudocirrhosis was 29.2 months. 50% of patients had stable or responding disease at the time of pseudocirrhosis diagnosis. Sequelae of pseudocirrhosis included radiographic ascites (n = 97, 80.8%), gastric/esophageal varices (n = 68, 56.7%), splenomegaly (n = 26, 21.7%), GI bleeding (n = 12, 10.0%), and hepatic encephalopathy (n = 11, 9.2%). Median survival was 7.9 months after pseudocirrhosis diagnosis. Radiographic ascites was associated with shorter survival compared to no radiographic ascites (42.8 vs. 76.2 months, p =  < 0.001).

Conclusions

This is the largest case series of patients with MBC and pseudocirrhosis. Nearly all patients had HR+ MBC and extensive liver metastases. Survival was short after pseudocirrhosis and prognosis worse with radiographic ascites.

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Data availability

The datasets generated during the current study are not publicly available in order to protect patient privacy.

References

  1. Young ST, Paulson EK, Washington K, Gulliver DJ, Vredenburgh JJ, Baker ME (1994) CT of the liver in patients with metastatic breast carcinoma treated by chemotherapy: findings simulating cirrhosis. AJR Am J Roentgenol 163(6):1385–1388. https://doi.org/10.2214/ajr.163.6.7992734

    Article  Google Scholar 

  2. Qayyum A, Lee GK, Yeh BM, Allen JN, Venook AP, Coakley FV (2007) Frequency of hepatic contour abnormalities and signs of portal hypertension at CT in patients receiving chemotherapy for breast cancer metastatic to the liver. Clin Imaging 31(1):6–10. https://doi.org/10.1016/j.clinimag.2006.09.028

    Article  Google Scholar 

  3. Adike A, Karlin N, Menias C, Carey EJ (2016) Pseudocirrhosis: a case series and literature review. Case Rep Gastroenterol 10(2):381–391. https://doi.org/10.1159/000448066

    Article  Google Scholar 

  4. Breast cancer-related pseudocirrhosis and esophageal varices—PubMed. https://pubmed-ncbi-nlm-nih-gov.ucsf.idm.oclc.org/15982406/. Accessed 11 Oct 2021

  5. Oliai C, Douek ML, Rhoane C et al (2019) Clinical features of pseudocirrhosis in metastatic breast cancer. Breast Cancer Res Treat 177(2):409–417. https://doi.org/10.1007/s10549-019-05311-y

    Article  Google Scholar 

  6. Lee SL, Chang ED, Na SJ et al (2014) Pseudocirrhosis of breast cancer metastases to the liver treated by chemotherapy. Cancer Res Treat Off J Korean Cancer Assoc 46(1):98–103. https://doi.org/10.4143/crt.2014.46.1.98

    Article  Google Scholar 

  7. Jeong WK, Choi SY, Kim J (2013) Pseudocirrhosis as a complication after chemotherapy for hepatic metastasis from breast cancer. Clin Mol Hepatol 19(2):190–194. https://doi.org/10.3350/cmh.2013.19.2.190

    Article  Google Scholar 

  8. Adler M, Tang I, Gach MW, MacFaul G (2019) Recurrent metastatic breast cancer presenting with portal hypertension and pseudocirrhosis. BMJ Case Rep CP 12(11):e231044. https://doi.org/10.1136/bcr-2019-231044

    Article  Google Scholar 

  9. Engelman D, Moreau M, Lepida A, Zaouak Y, Paesmans M, Awada A (2020) Metastatic breast cancer and pseudocirrhosis: an unknown clinical entity. ESMO Open 5(3):e000695. https://doi.org/10.1136/esmoopen-2020-000695

    Article  Google Scholar 

  10. Gopalakrishnan D, Shajihan A, Purysko AS, Abraham J (2021) Pseudocirrhosis in breast cancer—experience from an academic cancer center. Front Oncol 11:2574. https://doi.org/10.3389/fonc.2021.679163

    Article  Google Scholar 

  11. Hanauer DA, Barnholtz-Sloan JS, Beno MF et al (2020) Electronic Medical Record Search Engine (EMERSE): an information retrieval tool for supporting cancer research. JCO Clin Cancer Inform 4:454–463. https://doi.org/10.1200/CCI.19.00134

    Article  Google Scholar 

  12. Gu W, Hortlik H, Erasmus HP et al (2022) Trends and the course of liver cirrhosis and its complications in Germany: nationwide population-based study (2005 to 2018). Lancet Reg Health Eur 12:100240. https://doi.org/10.1016/j.lanepe.2021.100240

    Article  Google Scholar 

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Acknowledgements

This project was supported by the National Center for Advancing Translational Sciences and National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR001872. The EMERSE platform was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U24CA204863 and P30CA046592, as well as the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR000433 and UL1TR002240. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Funding

This project was supported by the National Center for Advancing Translational Sciences and National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR001872. The EMERSE platform was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U24CA204863 and P30CA046592, as well as the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR000433 and UL1TR002240. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Laura A. Huppert, Jennifer Callan, Melanie Majure, Michelle E. Melisko, Hope S. Rugo & A. Jo Chien

  2. Division of Radiology, University of California, San Francisco, San Francisco, CA, USA

    Zak Walker & Spencer Behr

  3. Division of Epidemiology and Biostatistics, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA

    Moming Li & Mi-Ok Kim

  4. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Danielle Brandman

Authors
  1. Laura A. Huppert
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  2. Zak Walker
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  3. Moming Li
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  4. Mi-Ok Kim
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  5. Jennifer Callan
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  7. Melanie Majure
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  11. A. Jo Chien
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Contributions

Study design and conception was done by LH, AJC, ZW, and SB. Clinical chart review was performed by LH and JC. Radiographic review was performed by ZW and SB. Data analysis was performed by LH with statistical support from ML and M-OK. The first draft of the manuscript was written by LH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laura A. Huppert.

Ethics declarations

Conflict of interest

Laura A. Huppert, Zak Walker, Moming Li, Mi-Ok Kim and Melanie Majure: no financial disclosures. Jennifer Callan: none relevant to this work. Employed by Arcus Biosciences, an oncology-focused biopharmaceutical company. Danielle Brandman: none relevant to this work. Research funding from Gilead, Genentech, Allergan, Conatus, Grifols. Michelle E. Melisko: research funding to institution: Astra Zeneca, Novartis, KCRN Research, Puma, Seattle Genetics. For spouse: Speaker bureau/honoraria: Genentech, Gilead, Astra Zeneca. Stock Ownership: Merrimac. Hope S. Rugo: research support for clinical trials through the University of California: Pfizer, Merck, Novartis, Lilly, Roche, Daiichi, Seattle Genetics, Macrogenics, Sermonix, Boehringer Ingelheim, AstraZeneca, Astellas and Gilead. Honoraria from: Puma, Samsung, Mylan, Chugai, Blueprint, and NAPO. Spencer Behr: none relevant to this work. Scientific Advisory Committee member for Navidea and Consultant for GenVivo. Jo Chien: research funding to institution: Merck, Puma, Amgen, Seagen.

Ethics approval

This research was approved by the UCSF Institutional Review Board.

Consent to participate and publish

Patient consent was not required given that this was a retrospective, observational study approved by the UCSF Institutional Review Board.

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Huppert, L.A., Walker, Z., Li, M. et al. Clinical characteristics and outcomes in patients with metastatic breast cancer and pseudocirrhosis: a single center retrospective cohort study. Breast Cancer Res Treat 197, 137–148 (2023). https://doi.org/10.1007/s10549-022-06771-5

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  • DOI: https://doi.org/10.1007/s10549-022-06771-5

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