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Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center

BACKGROUND: Pseudocirrhosis is characterized by radiological changes in the liver that resemble cirrhosis, but with more rapid onset and progression. Though reported most frequently in patients with metastatic breast cancer, little is known about its prognostic factors and impact on breast cancer ou...

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Autores principales: Gopalakrishnan, Dharmesh, Shajihan, Ain, Purysko, Andrei S., Abraham, Jame
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283693/
https://www.ncbi.nlm.nih.gov/pubmed/34277423
http://dx.doi.org/10.3389/fonc.2021.679163
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author Gopalakrishnan, Dharmesh
Shajihan, Ain
Purysko, Andrei S.
Abraham, Jame
author_facet Gopalakrishnan, Dharmesh
Shajihan, Ain
Purysko, Andrei S.
Abraham, Jame
author_sort Gopalakrishnan, Dharmesh
collection PubMed
description BACKGROUND: Pseudocirrhosis is characterized by radiological changes in the liver that resemble cirrhosis, but with more rapid onset and progression. Though reported most frequently in patients with metastatic breast cancer, little is known about its prognostic factors and impact on breast cancer outcomes. METHODS: In this observational study, we reviewed abdominal CT and/or MRI scan reports of all patients with invasive breast cancer diagnosed at our center, during a ten-year period, to identify patients with pseudocirrhosis. Exclusion criteria included lack of baseline imaging, pre-existing cirrhosis, hepatitis B or C, other chronic liver diseases, or heavy alcohol use. Routine descriptive statistical measures were used. Survival distributions were estimated using Kaplan-Meier method, and Cox regression was used for multivariate analysis. Two-tailed p < 0.05 was considered significant. RESULTS: Eighty-six patients were included – all were females, median age was 57.5 years, and 90% were Caucasian; 86% of primary tumors were hormone-receptor positive and 17% were HER2 positive. Most patients (98%) had metastatic disease with liver involvement (94%), and were heavily pre-treated – 97% with chemotherapy, 85% with hormonal therapy, and 19% with anti-HER2 agents. Median interval from breast cancer diagnosis to pseudocirrhosis was 75.4 months (IQR 35.2-115.3 months). Thirty-six percentage of patients had ≥1 signs of portal hypertension and 49% had ≥1 signs of hepatocellular failure. Pseudocirrhosis led to permanent discontinuation of chemotherapy, endocrine therapy, and all systemic therapies in 29%, 31%, and 20% patients, respectively. Median overall survival from diagnosis of pseudocirrhosis was 10.0 months (95%CI 5.2-14.8 months). On multivariate analysis, coagulopathy, hyperbilirubinemia, hypoalbuminemia, and cancer progression were independently predictive of mortality. CONCLUSIONS: In this largest series, to date, of breast cancer with pseudocirrhosis, the latter was often complicated by portal hypertension and hepatocellular failure, and markedly impacted breast cancer management. Survival was shorter for patients who developed hepatocellular failure.
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spelling pubmed-82836932021-07-17 Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center Gopalakrishnan, Dharmesh Shajihan, Ain Purysko, Andrei S. Abraham, Jame Front Oncol Oncology BACKGROUND: Pseudocirrhosis is characterized by radiological changes in the liver that resemble cirrhosis, but with more rapid onset and progression. Though reported most frequently in patients with metastatic breast cancer, little is known about its prognostic factors and impact on breast cancer outcomes. METHODS: In this observational study, we reviewed abdominal CT and/or MRI scan reports of all patients with invasive breast cancer diagnosed at our center, during a ten-year period, to identify patients with pseudocirrhosis. Exclusion criteria included lack of baseline imaging, pre-existing cirrhosis, hepatitis B or C, other chronic liver diseases, or heavy alcohol use. Routine descriptive statistical measures were used. Survival distributions were estimated using Kaplan-Meier method, and Cox regression was used for multivariate analysis. Two-tailed p < 0.05 was considered significant. RESULTS: Eighty-six patients were included – all were females, median age was 57.5 years, and 90% were Caucasian; 86% of primary tumors were hormone-receptor positive and 17% were HER2 positive. Most patients (98%) had metastatic disease with liver involvement (94%), and were heavily pre-treated – 97% with chemotherapy, 85% with hormonal therapy, and 19% with anti-HER2 agents. Median interval from breast cancer diagnosis to pseudocirrhosis was 75.4 months (IQR 35.2-115.3 months). Thirty-six percentage of patients had ≥1 signs of portal hypertension and 49% had ≥1 signs of hepatocellular failure. Pseudocirrhosis led to permanent discontinuation of chemotherapy, endocrine therapy, and all systemic therapies in 29%, 31%, and 20% patients, respectively. Median overall survival from diagnosis of pseudocirrhosis was 10.0 months (95%CI 5.2-14.8 months). On multivariate analysis, coagulopathy, hyperbilirubinemia, hypoalbuminemia, and cancer progression were independently predictive of mortality. CONCLUSIONS: In this largest series, to date, of breast cancer with pseudocirrhosis, the latter was often complicated by portal hypertension and hepatocellular failure, and markedly impacted breast cancer management. Survival was shorter for patients who developed hepatocellular failure. Frontiers Media S.A. 2021-07-02 /pmc/articles/PMC8283693/ /pubmed/34277423 http://dx.doi.org/10.3389/fonc.2021.679163 Text en Copyright © 2021 Gopalakrishnan, Shajihan, Purysko and Abraham https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Gopalakrishnan, Dharmesh
Shajihan, Ain
Purysko, Andrei S.
Abraham, Jame
Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center
title Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center
title_full Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center
title_fullStr Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center
title_full_unstemmed Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center
title_short Pseudocirrhosis in Breast Cancer – Experience From an Academic Cancer Center
title_sort pseudocirrhosis in breast cancer – experience from an academic cancer center
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283693/
https://www.ncbi.nlm.nih.gov/pubmed/34277423
http://dx.doi.org/10.3389/fonc.2021.679163
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