Letter to the editor Date 2012/August/31
Pyogenic liver abscess is a red flag sign of hepatocellular carcinoma Running head: pyogenic liver abscess and hepatocellular carcinoma Shih-Wei Lai, MD1,2
1School of Medicine, China Medical University, Taichung, 404, Taiwan
2Department of Family Medicine, China Medical University Hospital, Taichung, 404, Taiwan
To editor,
We read one paper recently published in Aliment Pharmacol Ther with interest about the association between pyogenic liver abscess (PLA) and subsequent hepatocellular carcinoma (HCC) risk. 1 By analyzing the Taiwan National Health Insurance
database, the authors have found that patients with PLA had a higher risk of HCC (standard incidence ratio 7.87, 95% CI 5.94-10.21). 1 Moreover, the most important issue is whether PLA is a risk factor for HCC or an early manifestation of
undiagnosed HCC. The authors also found that standard incidence ratio of HCC was relatively higher within one year after the diagnosis of PLA (standard incidence ratio 257.28, 95% CI 186.17–346.56). 1 In view of the clinical course, PLA might be only an early manifestation of underlying HCC rather than a risk factor, which has been shown in previous studies. To my opinion, PLA might be considered as a red flag sign of HCC, not a causal factor. Therefore, patients with PLA should receive an intensive surveillance for underlying HCC, especially in those with cirrhosis, hepatitis B virus infection, hepatitis C virus infection or age ≥ 65 years. 3
REFERENCES
1. Kao WY, Hwang CY, Chang YT, Su CW, Hou MC, Lin HC, Lee FY, Lee SD, Wu JC. Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study. Aliment Pharmacol Ther 2012; 36: 467-76.
2. Yeh TS, Jan YY, Jeng LB, Chen TC, Hwang TL, Chen MF. Hepatocellular carcinoma presenting as pyogenic liver abscess: characteristics, diagnosis, and management. Clin Infect Dis 1998; 26: 1224-6.
3. Lin YT, Liu CJ, Chen TJ, Chen TL, Yeh YC, Wu HS, Tseng CP, Wang FD, Tzeng CH, Fung CP. Pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma. Am J Med 2011; 124: 1158-64.
