CRC incidence significantly higher among patients with cryptogenic pyogenic liver abscess
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Key takeaways:
- More patients with pyogenic liver abscess were diagnosed with colorectal cancer vs. controls (1.9% vs. 0.8%).
- CRC incidence was highest in the first 3 years of PLA diagnosis.
Patients diagnosed with cryptogenic pyogenic liver abscess had a “significantly higher incidence” of colorectal cancer up to 3 years from diagnosis compared with matched controls, highlighting the importance of CRC screening, data showed.
“Certain infectious diseases, such as Streptococcus gallolyticus bacteremia, anaerobic bacteremia and pyogenic liver abscess (PLA), are reported to have an association with the incidence of CRC,” Hiroyuki Suzuki, MD, MSCI, of Iowa City Veterans Affairs Health Care System, and colleagues wrote in JAMA Network Open. “Despite preliminary data suggesting that patients who experienced PLA have a higher CRC incidence, there are no professional guidelines to recommend CRC screening for patients who are diagnosed with PLA.”
To further investigate the association between PLA and subsequent incidence of CRC, Suzuki and colleagues conducted a patient-level, matched retrospective cohort study of 8,286 patients diagnosed with PLA (mean age, 65.8 years; 96.5% men) and 23,201 controls (mean age, 65.3 years; 96.3% men) at 127 VHA hospitals from 2003 to 2020. Researchers noted that annual PLA incidence rates rose from 5.38 cases per 100,000 patient-years from 2003 to 2005 to 9.02 per 100,000 from 2018 to 2020.
Analysis revealed a significantly higher proportion of patients with PLA had a diagnosis of CRC compared with controls (1.9% vs. 0.8%). This incidence was highest among those diagnosed with PLA in the first 3 years (HR = 3.64; 95% 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 nonsignificant after 3 years.
Further, results showed no association between PLA and CRC diagnosis 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 those with cryptogenic PLA.
After adjusting for age and comorbidities, a subgroup analysis of 355 patients (159 with PLA and 196 controls) diagnosed with CRC during follow-up demonstrated higher hazards for mortality among patients with PLA up to 3 years from diagnosis of CRC.
“Patients who were diagnosed with cryptogenic PLA had a significantly higher incidence of CRC after 3 years from PLA diagnosis,” Suzuki and colleagues concluded. “These findings suggest that offering CRC screening to patients with cryptogenic PLA may be useful, especially in patients who have not been screened according to guidelines.”
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