Abstract
Pulmonary tuberculosis (TB) is a known risk factor for lung cancer. However, a detailed analysis of lung cancer type, age, sex, smoking, and TB burden associated with geographic and socioeconomic status has not been performed previously. We systematically appraised relevant observational studies reporting an association between pulmonary TB and lung cancer. All studies were included in the primary analysis, and studies that used robust TB diagnostic methods, such as validated medical diagnostic codes, were included in the secondary analysis. Thirty-two articles were included. The association between the history of pulmonary TB and diagnosis of lung cancer was statistically significant (OR 2.09, 95% CI: 1.62–2.69, p < 0.001). There was a high heterogeneity (I2 = 95%), without any publication bias. The analysis indicated a high association in advanced articles describing stringent pulmonary TB diagnosis (OR 2.26, 95% CI: 1.29–3.94, p = 0.004). The subgroup analyses suggested a significant association in countries with medium or high TB burdens, from East Asia and the Pacific region, and upper-middle income countries. Heterogeneity within the subgroups remained high in a majority of the subgroup analyses. A meta-regression analysis revealed that younger patients showed a significantly higher association between TB and lung cancer (regression coefficient = 0.949, p < 0.001). The history of pulmonary TB is an independent risk factor for lung cancer, especially in younger patients diagnosed with pulmonary TB. Clinicians should be aware of this association while treating young patients with a history of pulmonary TB.
Highlights
Lung cancer is one of the most common malignancies, with approximately 2.09 million new diagnoses worldwide in 2018
The economic income statuses of the countries reflected the characteristics of patients with TB, and the countries with upper-middle incomes (OR: 2.57, 95% confidence interval (CI): 1.68–3.93, p < 0.001) demonstrated a higher risk of lung cancer than high-income status countries (OR: 1.91, 95% CI: 1.41–2.59, p < 0.001)
As this study reviewed articles analyzing the relationship between the risk factors of pulmonary tuberculosis and lung cancer, the focus was mainly on the “diagnosis”
Summary
Lung cancer is one of the most common malignancies, with approximately 2.09 million new diagnoses worldwide in 2018. It accounts for approximately 18.4% of the total cancer-related deaths, the highest of all cancer types [1]. Cigarette smoking has been a major causal factor for lung cancer since 1912 [2,3,4]. Environmental factors such as air pollution, nutrition, occupational exposure, and a family history of previous cancer are related to lung cancer. With the recent development of molecular diagnosis, research on genetic or inflammatory factors that contribute to lung carcinogenesis is being actively conducted [5,6]
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