Pyogenic Liver Abscess Increases Colorectal Cancer Risk - EMJ

Pyogenic Liver Abscess Increases Colorectal Cancer Risk

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PATIENTS diagnosed with cryptogenic pyogenic liver abscess (PLA) had a significantly higher incidence of colorectal cancer (CRC) up to 3 years after PLA diagnosis compared with control patients, according to recent data.

Hiroyuki Suzuki, Iowa City Veterans Affairs Health Care System, USA, and colleagues, conducted a patient-level, matched retrospective cohort study of 8,286 patients diagnosed with PLA from 2003–2020 (mean age: 65.8 years; 96.5% male) at 127 Veterans Affairs hospitals. All patients who were admitted to the hospital system with a diagnosis of PLA were included, and patients were followed up to 10 years from PLA diagnosis. A total of 23,201 controls were selected to match the age, sex, and healthcare facility of patients with PLA (mean age: 65.3 years; 96.3% male).

The team found that a significantly higher proportion of patients with PLA had a diagnosis of CRC compared with controls (1.9% versus 0.8%). This incidence was highest among those diagnosed with PLA during the first 3 years from diagnosis (hazard ratio [HR]: 3.64; 95% confidence interval [CI]: 2.7–4.91 at 0.5 years; HR: 2.51; 95% CI: 1.93–3.26 at 1 year; HR: 1.74; 95% CI: 1.33–2.28 at 2 years; and HR: 1.41; 95% CI: 1.05–1.89 at 3 years), and not significant after 3 years. This association was not observed among patients whose PLA was likely secondary to cholangitis or cholecystitis (HR: 1.78; 95% CI: 0.89–3.56 at 0.5 years). Conversely, researchers noted a significant increase in CRC incidence among patients with cryptogenic PLA.

Furthermore, a subgroup analysis of 355 patients diagnosed with CRC during follow-up (159 with PLA; 196 controls) revealed a higher risk for mortality among patients with PLA, up to 3 years from CRC diagnosis.

“Certain infectious diseases, such as Streptococcus gallolyticus bacteremia, anaerobic bacteremia, and PLA, are reported to have an association with the incidence of CRC,” reported Suzuki. However, he emphasised that there are currently no professional guidelines to recommend CRC screening for patients diagnosed with PLA. The authors concluded that offering CRC screening to patients with cryptogenic PLA may be useful, especially for those who have not been screened according to guidelines.

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