Pseudocirrhosis and portal hypertension in patients with metastatic cancers: a systematic review and meta-analysis

Abstract

Pseudocirrhosis is a clinical and radiological entity mimicking liver cirrhosis in patients without a history of chronic liver disease. We performed a systematic review and meta-analysis of the current literature to evaluate the state-of-the-art and investigate the epidemiology and clinical features of pseudocirrhosis. We searched PubMed, Web of Science and Scopus for literature published until February 28, 2022. We included in the final analysis 62 articles (N = 389 patients): 51 case reports (N = 64 patients), 5 case series (N = 35 patients) and 6 observational studies (N = 290 patients). About 80% of patients included in the case reports and case series had breast cancer. Most patients had at least one clinical sign of portal hypertension and ascites was the most common clinical manifestation of portal hypertension. The median time from pseudocirrhosis to death was 2 months (IQR 1–7 months). Alkylating agents and antimitotics were the most common classes of anticancer drugs reported in our study population. Notably, about 70% of patients received three or more anticancer drugs. Finally, pseudocirrhosis is a condition that occurs in patients with hepatic metastases and may have a negative impact on survival and clinical management of patients because of the potential development of portal hypertension and its complications.

Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature

“…Pseudocirrhosis is a radiologic diagnosis that describes morphologic changes of the liver mimicking cirrhosis that arise in the setting of metastatic malignancy. Most cases in the published literature are found in metastatic breast cancer [ 1 , 4 , 6 , 26 , 54 ], but cases have been reported in other primary malignancies, including pancreatic [ 43 ], colorectal [ 44 , 45 ], gastric [ 46 – 48 ], esophageal [ 49 ], lung [ 50 , 51 ], ovarian [ 52 ], and medullary thyroid cancers [ 53 ].…”

“…In 1924, the earliest report of irregular, lobulated hepatic pathologic changes in a case of metastatic breast cancer described the findings as “hepar lobatum carcinomatosum” [ 5 , 6 ]. This term was borrowed from the similar gross pathologic appearance with “hepar lobatum,” a complication of gummatous tertiary syphilis resulting in areas of hepatic fibrosis and hyperplasia [ 7 – 9 ].…”

“…In 1994, Young et al first applied the term “pseudocirrhosis” to describe cirrhosis-like hepatic changes in metastatic disease [ 16 ]. In recent history, “pseudocirrhosis” has been the dominant term in the literature used to describe this clinical and radiographic finding [ 6 , 17 ].…”

“…An extensive review of pseudocirrhosis was recently published [ 6 ]. Few studies have characterized the natural history of patients with pseudocirrhosis [ 25 , 26 ].…”

Colorectal Surgery in Patients with Liver Cirrhosis: A Systematic Review

“…In this systematic review, there are studies that define cirrhosis are based only on either ascites [16], portal hypertension or varices as standalone criteria [12, 18] even though these isolated findings can be due to other causes. Some of these features could be also be secondary to pseudo‐cirrhosis which has similar clinical and radiological features to cirrhosis in the setting of hepatic metastases [30].…”