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Pyogenic Liver Abscess as the Initial Manifestation of Underlying Hepatocellular Carcinoma - 24/11/11

Doi : 10.1016/j.amjmed.2011.08.012 
Yi-Tsung Lin, MD a, b, Chia-Jen Liu, MD c, Tzeng-Ji Chen, MD b, d, Te-Li Chen, MD, PhD a, b, Yi-Chen Yeh, MD b, e, Hau-Shin Wu, MD a, Chih-Peng Tseng, MD a, Fu-Der Wang, MD a, b, Cheng-Hwai Tzeng, MD b, c, Chang-Phone Fung, MD a, b,
a Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 
b School of Medicine, National Yang-Ming University, Taipei, Taiwan 
c Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 
d Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 
e Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 

Requests for reprints should be addressed to Chang-Phone Fung, MD, Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, 112 Taipei, Taiwan

Abstract

Background

Pyogenic liver abscess and hepatocellular carcinoma are common in Taiwan. We investigated the frequency of, risk factors for, and prognosis of pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma over a 12-year period in Taiwan.

Methods

We extracted 32,454 patients with pyogenic liver abscess from a nationwide health registry in Taiwan during the period 1997-2008. The frequency of and risk factors for pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma were determined. The prognosis of these patients was compared with patients with hepatocellular carcinoma but without liver abscess.

Results

A total of 698 (2.15%) patients presented with liver abscess as the initial manifestation of underlying hepatocellular carcinoma during the 12-year period. Liver cirrhosis, hepatitis B virus infection, hepatitis C virus infection, and age ≥65 years were independent risk factors for liver abscess as the initial manifestation of underlying hepatocellular carcinoma. Furthermore, these patients had a lower 2-year survival rate than patients with hepatocellular carcinoma but without liver abscess (30% vs 37%; P=.004).

Conclusions

The prognosis of patients who presented with pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma was poor. Physicians should not ignore the possibility of underlying hepatocellular carcinoma in patients with risk factors for the disease in regions with a high prevalence of both pyogenic liver abscess and hepatocellular carcinoma.

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Keywords : Hepatocellular carcinoma, Population study, Pyogenic liver abscess


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 Funding: This work was supported partly by grants from Taipei Veterans General Hospital (V100D-002-3).
 Conflict of Interest: None.
 Authorship: This work is original, and all authors significantly contributed to this article and accept responsibility for its scientific content. Yi-Tsung Lin and Chia-Jen Liu have equal contribution to this article.


© 2011  Elsevier Inc. Reservados todos los derechos.
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Vol 124 - N° 12

P. 1158-1164 - décembre 2011 Regresar al número
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