Abstract P3-14-04: Hepatic pseudocirrhosis in breast cancer – analyses of clinical and prognostic factors
Authors: Gopalakrishnan D , Abraham J 
Published: February 2018

Background

Hepatic pseudocirrhosis (HP) is a rare entity characterized by radiological changes in the liver resembling cirrhosis (lobular contour, nodularity, capsular retraction, and atrophy), reported most frequently in patients (pts) with treated metastatic breast cancer (BC). Cases in literature have been associated with poorer prognosis than true cirrhosis with fatal outcome nearly always in a few months. Little is known about factors which predispose to HP or influence its prognosis.

Methods

In this retrospective observational study, we reviewed abdominal radiology reports (CT, MRI, and ultrasound scans) of all our pts with BC diagnosed between 01/01/07 and 12/31/16, to identify those with HP. Cirrhosis on baseline imaging, pre-existing chronic liver disease, hepatitis B/C, and heavy alcohol use were exclusion criteria. Routine descriptive statistical measures were employed. Multiple regression was used to analyze factors affecting survival. p &lt;0.05 was considered significant.

Results

We identified 86 pts with HP who satisfied inclusion/exclusion criteria. All were females, 89.5% were Caucasian. 83.7% of primary tumors were ER+, 58.1% were PR+ and 17.4% were HER2+. 25.6% had an invasive lobular component. The vast majority had distant metastases (mets) (97.7%) and liver mets (94.2%) at the time of diagnosis of HP, though 52.3% had stage I/II BC on initial presentation. Median size of the largest liver met was 30.0 mm and 87.2% pts had &gt;10 liver mets. Most pts were heavily pre-treated before the manifestation of HP – 84.9% had received hormonal therapy (median cumulative duration of 35 months each of tamoxifen and aromatase inhibitors), 18.6% got anti-HER2 therapy (median duration of 15 months), and 96.5% received chemotherapy (81.4% had received ≥ 2 lines of chemotherapy). Median interval from diagnosis of BC to detection of HP was 6.3 years (IQR 2.9-9.6). 36% had ≥1 signs of portal hypertension (splenomegaly 15.1%, esophageal/gastric varices 18.6%, variceal bleeding 9.3% and ascites with high albumin gradient 34.9%), while 48.8% had ≥1 signs of hepatocellular failure (jaundice 47.7%, coagulopathy 30.2%, hepatic encephalopathy 14.0%). Detection of HP often led to changes in BC therapy – chemotherapy was changed in 46.5% pts, stopped in 24.4%, hormonal therapy was changed in 18.6%, stopped in 15.1%, and hospice care was initiated in 19.8% pts. Status of BC and liver mets at initial detection of HP were variable – 53.5% had disease progression while 45.3% had continued response; 40.7% had enlarging, 23.4% had stable and 30.9% had shrinking liver mets. Median survival after detection was HP was 3.6 months (1.1-11.5). Death was due to BC-progression in 83.4% pts and HP-related complications (GI bleeding, hepatic failure) contributed in 28.6% pts. Using multiple regression, lower albumin level and a higher number of metastatic sites at initial detection of HP were found to be independently associated with shorter post-HP survival (R2 16.6%, F(2,74) 7.37, p=0.001).

Conclusions

We report the largest series, till date, of BC patients with HP, an entity which can be complicated by portal hypertension and hepatocellular failure, and with marked impact on BC survival and management. Studies are needed to identify risk factors and management strategies.

Citation Format: Gopalakrishnan D, Abraham J. Hepatic pseudocirrhosis in breast cancer – analyses of clinical and prognostic factors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-04.