Clinical and radiographic characteristics of patients with metastatic breast cancer and pseudocirrhosis: A single-center retrospective cohort study.
Authors: Huppert Laura Ann , Walker Zak , Li Moming , Kim Mi-Ok , Callan Jennie , Majure Melanie , Melisko Michelle E. , Rugo Hope S. , Behr Spencer , Chien Amy Jo 
Published: June 2022

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Background: 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); the pathophysiology and clinical consequences are poorly understood. The objective of this study is to describe the patient, tumor, and treatment characteristics associated with pseudocirrhosis, and to assess associated clinical outcomes. Methods: In this retrospective study, we identified patients with MBC and imaging findings consistent with pseudocirrhosis (diffuse liver contour abnormalities) who were treated at the University of California San Francisco from 2002-2021. We used chart extraction and radiology review to determine demographic characteristics, treatment history, response to treatment, imaging features, and complications of pseudocirrhosis. Comparisons between groups were made using the unpaired t-test or two-sided Fisher’s exact test. Results: 120 patients with MBC and radiographic evidence of 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 with pseudocirrhosis had liver metastases (n = 120, 100.0%) and 82.5% (n = 99) had > 15 lesions. Median time from diagnosis of MBC to radiographic evidence of pseudocirrhosis was 29.2 months. Most patients received chemotherapy for MBC prior to the finding of pseudocirrhosis (n = 111, 92.5%) with median 2.0 lines. Pseudocirrhosis was observed in the setting of stable or responding disease in 50% of patients (n = 60). Patients received a median of 1.0 line of additional therapy after pseudocirrhosis diagnosis, with a median overall survival of 7.9 months from pseudocirrhosis to death. Sequelae of pseudocirrhosis included the radiographic finding of ascites (n = 97, 80.8%), gastric/esophageal varices (n = 68, 56.7%), splenomegaly (n = 26, 21.7%), GI bleeding (n = 12, 10.0%), or hepatic encephalopathy (n = 11, 9.2%). Radiographic evidence of ascites was associated with a shorter survival from MBC diagnosis compared to no ascites (42.8 vs. 76.2 months, p = < 0.001). GI/Hepatology consultation was uncommon (n = 9, 7.5%). Conclusions: To our knowledge, this is the largest reported case series of patients with MBC and pseudocirrhosis. Nearly all patients had HR+ disease and extensive liver metastases. Pseudocirrhosis was frequently observed in the setting of responding or stable disease, creating complexity in management. Survival was short in all patients, particularly patients with radiographic evidence of ascites. Further understanding of the pathogenesis of and risk factors for pseudocirrhosis could help improve outcomes for this condition.