Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.
J Gastrointest Surg. 2011 Nov;15(11):2036-43. doi: 10.1007/s11605-011-1650-3. Epub 2011 Aug 9.
Pyogenic liver abscess (PLA) of cancer patients often has a poor prognosis, but corresponding prognostic factors are less investigated. This study aimed to identify predictors of mortality in cancer patients with PLA.
Medical records of 85 consecutive cancer patients (46 with hepatobiliary pancreatic cancer, 14 with gastrointestinal cancer, and 25 with non-digestive system cancer) having PLA who were admitted to two university hospitals were retrospectively reviewed. The predictors of mortality were determined using Cox regression model.
The overall case fatality rate was 33%. In multivariate analysis, the greater Acute Physiology and Chronic Health Evaluation II score (P = 0.028), multiloculated abscess (P = 0.025), and polymicrobial infection (P = 0.003) were associated with mortality. In subgroup analysis of the 25 patients with multiloculated abscess undergoing percutaneous catheter drainage as primary treatment, the case fatality rates of patients with a solitary smaller abscess (size < 5 cm), those with a solitary larger abscess (size > 5 cm), and those with larger multiple abscesses were 0%, 36%, and 85%, respectively (P = 0.002; using χ (2) for trend).
The advanced disease stage, multiloculated abscess, and polymicrobial infection posed a greater mortality risk in cancer patients with PLA. Moreover, an early surgical approach should be considered for cancer patients having large, multiloculated complex PLAs.
癌症患者并发化脓性肝脓肿（PLA）的预后通常较差，但相关预后因素研究较少。本研究旨在确定癌症合并 PLA 患者死亡的预测因素。
回顾性分析了两家大学医院收治的 85 例连续癌症患者（46 例肝胆胰癌、14 例胃肠道癌和 25 例非消化系统癌）的病历资料，这些患者均患有 PLA。使用 Cox 回归模型确定死亡的预测因素。
总体病死率为 33%。多因素分析显示，急性生理学和慢性健康评估 II 评分较高（P = 0.028）、多房脓肿（P = 0.025）和混合微生物感染（P = 0.003）与死亡率相关。在接受经皮导管引流作为主要治疗的 25 例多房脓肿患者的亚组分析中，单房较小脓肿（<5cm）、单房较大脓肿（>5cm）和多个较大脓肿患者的病死率分别为 0%、36%和 85%（P = 0.002；采用 χ²趋势检验）。
晚期疾病状态、多房脓肿和混合微生物感染使癌症合并 PLA 患者的死亡率更高。此外，对于患有大型、多房复杂 PLA 的癌症患者，应考虑早期手术治疗。
