Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
PLoS One. 2021 May 7;16(5):e0250531. doi: 10.1371/journal.pone.0250531. eCollection 2021.
Tuberculosis (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.
In 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.
During 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.
A 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.
结核病（TB）在全球范围内构成威胁，肺部是常见的转移灶部位。先前的研究表明，在结核病诊断后 20 多年内，TB 可能使原发性肺癌的风险增加两倍。然而，尚无大规模研究评估 TB 和继发性肺癌的风险。因此，我们使用全国性基于人群的数据集评估了患有或未患有结核病（TB）的患者发生继发性肺癌的风险。
在一项针对 1936512 人的队列研究中，我们根据 2000 年至 2015 年的国际疾病分类（ICD-p-CM）代码 010-011，从原发性癌症和 TB 感染患者中选择了 6934 例患者。对照组包括 13868 例随机选择的、具有可比性的患者（按年龄、性别和索引日期），没有 TB 暴露。使用此调整后的日期，使用 Cox 比例风险回归模型估计 TB 与发生继发性肺癌风险之间的可能关联。
在随访期间，761 例（10.97%）TB 患者和 1263 例（9.11%）无 TB 患者被诊断出患有继发性肺癌。在调整了混杂因素后，TB 组原发性癌症患者发生继发性肺癌的风险比无 TB 组高 1.67 倍。分层分析显示，与无 TB 组相比，每一种合并症（包括糖尿病、高血压、肝硬化、充血性心力衰竭、心血管意外、慢性肾脏病、慢性阻塞性肺疾病）都显著增加了继发性肺癌的风险。此外，原发性癌症类型（包括头颈部、结直肠癌、软组织肉瘤、乳腺癌、肾脏和甲状腺癌）发生继发性肺癌的风险更高。
TB 与原发性癌症和合并症的继发转移风险之间存在显著关联。因此，TB 患者应评估继发肺癌的风险。
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