Should patients with pyogenic liver abscess be screened for colorectal cancer?

Review by Prof. Mark Topazian (USA)

Study Summary 

Some infections may be associated with underlying colorectal cancer (CRC), including streptococcus bovis and clostridium septicum bacteremias. Pyogenic liver abscess (PLA) has been associated with comorbidities such as diabetes and splenectomy, and previous studies suggested an association with colorectal cancer in East Asian patients (particularly those infected with klebsiella pneumoniae). In this retrospective cohort study, investigators analyzed health records from 8,286 PLA patients and 23,201 matched controls from 127 hospitals in the United States Veterans Health Administration system.

Patients with PLA had double the risk of a subsequent CRC diagnosis compared to controls (1.9% vs. 0.8%). The risk of a CRC diagnosis was particularly high within 6 months of PLA diagnosis (hazard ratio, 3.64), declining gradually over the next 3 years. No association between PLA and CRC was observed in patients whose PLA was attributed to biliary tract diseases such as cholangitis or cholecystitis.

Commentary 

Data from East Asia and the United States now support an association between PLA and underlying CRC, particularly in patients whose PLA is not attributable to biliary tract disease. PLA is relatively common in tropical regions, and we lack information about whether an association with CRC is present in most of these parts of the globe. However, the available data appear to justify offering CRC screening to PLA patients.

Citation

Suzuki H, Kidder I, Tanaka T, et al. Incidence of Colorectal Cancer in Patients Diagnosed With Pyogenic Liver Abscess. JAMA Netw Open. 2023;6(12):e2348218. doi:10.1001/jamanetworkopen.2023.48218

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