Epidemiology of Aspergillosis in Cancer Patients in Taiwan

Abstract

Purpose The incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. There are limited data about the incidence of aspergillosis in patients with different types of cancer. The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017. Patients and Methods Data were collected from the Taiwan Cancer Registry database and International Classification of Diseases, 9th, 10th Revision, and Clinical Modification codes for diagnosing aspergillosis. Patients with a history of aspergillosis before cancer were excluded, and the secondary outcome was the risk of mortality in cancer patients with and without aspergillosis after 1 year. Results Among 951 cancer patients with a diagnosis of aspergillosis, there were 614 hematopoietic and reticuloendothelial system patients, 100 lung cancer patients, and 73 lymphoma cancer patients. The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: <0.0001). Regarding sex, the incidence rates of aspergillosis in males and females were 12.52 and 7.53 per 10,000 person-years, respectively. Patients with a diagnosis of aspergillosis had a 2.30-fold (95% CI: 2.14–2.48, p value: <0.0001) higher risk of mortality than those without aspergillosis. Conclusion The incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis.

Navigating the challenges of invasive pulmonary aspergillosis in lung cancer treatment: a propensity score study

“…A recent review article and case report also emphasized that immunotherapy may induce infection complications due to dysregulated immunity. 15,16 The European Society of Clinical Microbiology and Infectious Diseases proposed a consensus statement that immunosuppressive therapy to treat immune-related adverse events contributes to the risk of opportunistic infections compared to using ICIs alone. 22 In our study, there was only a nonsignificant trend in increasing IPA risk with steroid use.…”

“…They found that 16 of 1200 (1.6%) patients met the CPA diagnosis criteria. 21 Chen et al 15 showed that the incidence rate of pulmonary aspergillosis among male and female patients with all stages of lung cancer was 12.52 and 7.53 per 10,000 person-years, respectively. In our study, the prevalence may be underestimated since only 290 of 2543 advanced lung cancer patients received GM testing.…”

“…Finally, after excluding patients not receiving cancer treatment at the time of their GM test, the HRs for 1-year and 2-year survival post-GM test were 1.91 (95% CI: 1.12-3.24) and 2.12 (95% CI: 1.29-3.48), respectively (Supplemental Table 6). 21 Chen et al 15 showed that the incidence rate of pulmonary aspergillosis among male and female patients with all stages of lung cancer was 12.52 and 7.53 per 10,000 person-years, respectively. In our study, the prevalence may be underestimated since only 290 of 2543 advanced lung cancer patients received GM testing.…”

“…A previous epidemiological investigation using the Taiwan Cancer Registry database found a crude IPA incidence of 0.12 per 100 patients, and patients with aspergillosis were also associated with higher mortality. 15 To our knowledge, few biology-based and treatment-stratified studies have explored IPA’s prevalence in patients with advanced-stage lung cancer and their survival or IPA risk factors. While chemotherapy is a well-known risk factor for IPA, 9 there is limited data available on the association between the use of ICIs and the risk of IPA.…”

Aspergillosis: The Disease at a Glance. Review Article

“…There are very limited data available about the incidence of aspergillosis in patients suffering from cancer. However, an increasing trend of aspergillosis has been observed in cancer patients (Chien et al 2022) [26]. Sometimes, the invasive pulmonary aspergillosis (IPA) is found mimicking as the metastatic lung cancer (Michiel et al 2018) [27].…”