Letter: pyogenic liver abscess is a red flag sign of hepatocellular carcinoma


E-mail: wei@mail.cmuh.org.tw


I read the paper by Kao et al. about the association between pyogenic liver abscess (PLA) and subsequent hepatocellular carcinoma (HCC) risk with interest.[1] By analysing 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 1 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 may be only an early manifestation of underlying HCC rather than a risk factor, which has been shown in previous studies.[2, 3]

In 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]


Declaration of personal and funding interests: None.