Pyogenic liver abscesses in cancer patients

Objective. To analyse the clinical behaviour of pyogenic liver abscesses among cancer patients, and to determine whether there is any difference between clinical behaviour among patients without malignancies. Patients and methods. Retrospective, multicentric study with 133 patients with pyogenic liver abscesses diagnosed during 13 years. Patients were divided into two groups: 29 patients with malignant tumors identified during the five years prior to abscess development (group 1) and 104 patients without malignant tumors (group 2). Clinical, biological and bacteriological findings, morphology and lesional topography, treatment and particularly, clinical course were analysed. Results. Abscesses with portal pathogenesis were more common in group 1 (24% versus 10%; p=0.03). Clinical and biological data were similar in both group but jaundice (31% versus 18%; p = 0.09), liver enlargement (38% versus 21%; p = 0.06) and pleural effusion (48% versus 28%; p = 0.03), which were more common in group 1. In the same group, the mean AST level was also higher (112 +/- 149 versus 60 +/- 88; p = 0.07). Morphology and lesional topography, as well as bacteriology in both groups did not differ significantly. In group 1, surgical drainage was performed less frequently (21% versus 38%; p = 0.09) and mortality rate was higher (24% versus 11%; p = 0.08). Nevertheless, no significant differences were observed between hospital stay and morbidity. Among patients treated with antibiotics only, the mortality rate was higher in group 1 (50% versus 10%; p = 0.06). Conclusions. In pyogenic liver abscess in patients with malignant tumor disease a predominance of portal pathogenesis was observed. The presence of cancer among patients with pyogenic liver abscesses did not imply a significantly different clinical presentation; however, the clinical course was worse than that observed in cases without cancer.