Abstract
BackgroundTuberculosis (TB) presents a global threat in the world and the lung is the frequent site of metastatic focus. A previous study demonstrated that TB might increase primary lung cancer risk by two-fold for more than 20 years after the TB diagnosis. However, no large-scale study has evaluated the risk of TB and secondary lung cancer. Thus, we evaluated the risk of secondary lung cancer in patients with or without tuberculosis (TB) using a nationwide population-based dataset.MethodsIn a cohort study of 1,936,512 individuals, we selected 6934 patients among patients with primary cancer and TB infection, based on the International Classification of Disease (ICD-p-CM) codes 010–011 from 2000 to 2015. The control cohort comprised 13,868 randomly selected, propensity-matched patients (by age, gender, and index date) without TB exposure. Using this adjusted date, a possible association between TB and the risk of developing secondary lung cancer was estimated using a Cox proportional hazards regression model.ResultsDuring the follow-up period, secondary lung cancer was diagnosed in 761 (10.97%) patients with TB and 1263 (9.11%) patients without TB. After adjusting for covariates, the risk of secondary lung cancer was 1.67 times greater among primary cancer in the cohort with TB than in the cohort without TB. Stratification revealed that every comorbidity (including diabetes, hypertension, cirrhosis, congestive heart failure, cardiovascular accident, chronic kidney disease, chronic obstructive pulmonary disease) significantly increased the risk of secondary lung cancer when comparing the TB cohort with the non-TB cohort. Moreover, the primary cancer types (including head and neck, colorectal cancer, soft tissue sarcoma, breast, kidney, and thyroid cancer) had a more significant risk of becoming secondary lung cancer.ConclusionA significant association exists between TB and the subsequent risk for metastasis among primary cancers and comorbidities. Therefore, TB patients should be evaluated for the subsequent risk of secondary lung cancer.
Highlights
Tuberculosis (TB) presents a global threat in both developing and developed countries
A nationwide, population-based, matched cohort study is needed to clarify the association between TB infection and secondary lung cancer
TB was associated with a 1.67-fold increase in the risk of secondary lung cancer compared with the non-TB cohort after adjusting for numerous potential confounders
Summary
Tuberculosis (TB) presents a global threat in both developing and developed countries. About 20% to 54% of malignant tumors developing elsewhere in our body have pulmonary metastasis [2, 3] This is so-called secondary lung cancer when cancer cells have spread to the lungs from cancer that started elsewhere in the body. A nationwide, population-based, matched cohort study is needed to clarify the association between TB infection and secondary lung cancer. We have conducted this study to investigate whether comorbidities could attenuate the risk of developing secondary lung cancer after TB infection. Tuberculosis (TB) presents a global threat in the world and the lung is the frequent site of metastatic focus. No large-scale study has evaluated the risk of TB and secondary lung cancer. We evaluated the risk of secondary lung cancer in patients with or without tuberculosis (TB) using a nationwide population-based dataset
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