Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
Eur Respir Rev. 2022 Jul 27;31(165). doi: 10.1183/16000617.0025-2022. Print 2022 Sep 30.
People with tuberculosis experience long-term health effects beyond cure, including chronic respiratory diseases. We investigated whether tuberculosis is a risk factor for subsequent lung cancer.
We searched PubMed, Scopus, Cochrane, Latin American and Caribbean Health Sciences Literature and the Scientific Electronic Library Online for cohort and case-control studies providing effect estimates for the association between tuberculosis and subsequent lung cancer. We pooled estimates through random-effects meta-analysis. The study was registered in PROSPERO (CDR42020178362).
Out of 6240 records, we included 29 cohort and 44 case-control studies. Pooled estimates adjusted for age and smoking (assessed quantitatively) were hazard ratio (HR) 1.51 (95% CI 1.30-1.76, I=81%; five studies) and OR 1.74 (95% CI 1.42-2.13, I=59%; 19 studies). The occurrence of lung cancer was increased for 2 years after tuberculosis diagnosis (HR 5.01, 95% CI 3.64-6.89; two studies), but decreased thereafter. Most studies were retrospective, had moderate to high risk of bias, and did not control for passive smoking, environmental exposure and socioeconomic status. Heterogeneity was high.
We document an association between tuberculosis and lung cancer occurrence, particularly in, but not limited to, the first 2 years after tuberculosis diagnosis. Some cancer cases may have been present at the time of tuberculosis diagnosis and therefore causality cannot be ascertained. Prospective studies controlling for key confounding factors are needed to identify which tuberculosis patients are at the highest risk, as well as cost-effective approaches to mitigate such risk.
结核病患者在治愈后会长期受到健康影响，包括慢性呼吸道疾病。我们研究了结核病是否是随后发生肺癌的一个危险因素。
我们在 PubMed、Scopus、Cochrane、拉丁美洲和加勒比健康科学文献以及科学电子图书馆在线检索了队列研究和病例对照研究，这些研究提供了结核病与随后发生肺癌之间关联的效应估计值。我们通过随机效应荟萃分析对估计值进行了汇总。该研究已在 PROSPERO（CDR42020178362）中注册。
在 6240 条记录中，我们纳入了 29 项队列研究和 44 项病例对照研究。经过年龄和吸烟（定量评估）调整后的合并估计值为危险比（HR）1.51（95%CI 1.30-1.76，I=81%；五项研究）和比值比（OR）1.74（95%CI 1.42-2.13，I=59%；19 项研究）。在结核病诊断后 2 年内，肺癌的发生风险增加（HR 5.01，95%CI 3.64-6.89；两项研究），但此后风险降低。大多数研究为回顾性研究，存在中度至高度偏倚风险，且未控制被动吸烟、环境暴露和社会经济地位等因素。异质性很高。
我们记录了结核病与肺癌发生之间的关联，特别是在结核病诊断后的 2 年内，但不仅限于此。一些癌症病例可能在结核病诊断时就已经存在，因此无法确定因果关系。需要进行前瞻性研究，控制关键混杂因素，以确定哪些结核病患者风险最高，并找到降低这种风险的具有成本效益的方法。
