Lee Hwa Young, Kang Hye Seon, Kang Ji Young, Kim Jin Woo, Lee Sang Haak, Kim Seung Joon, Yeo Chang Dong
Division of Allergy, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal medicine, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Transl Cancer Res. 2022 Aug;11(8):2671-2680. doi: 10.21037/tcr-22-272.
The diagnosis of pulmonary tuberculosis (TB) in patients suspected of lung cancer is difficult because of the similarities in signs, symptoms, and radiologic results. The clinical and radiologic characteristics of the co-occurrence of pulmonary TB and lung cancer have not been fully evaluated.
Patients diagnosed with lung cancer and active pulmonary TB from January 2009 to December 2017 in four hospitals of the Catholic University of Korea were retrospectively reviewed. The clinical characteristics, including the TB diagnosis methods, lung cancer pathology, staging, initial radiographic features, and survival were analyzed and compared to 575 lung cancer patients without active pulmonary TB from the same hospitals.
Forty-eight (0.48%) of the 9,936 lung cancer patients had active pulmonary TB confirmed for at the time of the initial cancer diagnosis. The majority of the patients (95.9%) had non-small cell lung cancer and the most frequent findings were a mass-like lesion (79.2%) and separate nodules (75%). When compared to lung cancer patients without TB, the body mass index (BMI) was lower (21.4 23.1, P=0.001) and clinical stages were advanced in the lung cancer patients with TB; T3-4 (70.9% 50.6%, P=0.002), N2-3 (85.2% 55.6%, P<0.001); M1 (65.9% 44.5%, P=0.007). Interestingly, lung cancer with TB was associated with lower mortality [hazard ratio (HR) =0.35, 95% CI: 0.21-0.60].
Rarely diagnosed concurrent active TB in lung cancer patients was associated with lower BMI and advanced clinical stages. Active investigation of and treatment for active pulmonary TB in lung cancer patients might possibly improve patient outcomes.
疑似肺癌患者的肺结核（TB）诊断较为困难，因为其体征、症状和影像学结果存在相似之处。肺结核与肺癌同时发生的临床和影像学特征尚未得到充分评估。
对2009年1月至2017年12月在韩国天主教大学四家医院诊断为肺癌和活动性肺结核的患者进行回顾性研究。分析临床特征，包括结核病诊断方法、肺癌病理、分期、初始影像学特征和生存率，并与同医院575例无活动性肺结核的肺癌患者进行比较。
9936例肺癌患者中有48例（0.48%）在初次癌症诊断时确诊为活动性肺结核。大多数患者（95.9%）患有非小细胞肺癌，最常见的表现为肿块样病变（79.2%）和散在结节（75%）。与无结核病的肺癌患者相比，合并结核病的肺癌患者体重指数（BMI）较低（21.4对23.1，P=0.001），临床分期较晚；T3-4期（70.9%对50.6%，P=0.002），N2-3期（85.2%对55.6%，P<0.001）；M1期（65.9%对44.5%，P=0.007）。有趣的是，合并结核病的肺癌患者死亡率较低[风险比（HR）=0.35，95%置信区间：0.2-0.60]。
肺癌患者中罕见的并发活动性结核病与较低的BMI和晚期临床分期相关。对肺癌患者的活动性肺结核进行积极检查和治疗可能会改善患者的预后。
