Pulmonary Tuberculosis and Risk of Lung Cancer: A Systematic Review and Meta-Analysis

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.

Tuberculosis and risk of cancer: A systematic review and meta-analysis

“…More recent systematic reviews found similar results in pulmonary [11,40] and non-pulmonary cancers [12] post-TB. In these studies, pooled risk of lung cancer ranged from 1.96 to 2.17 [11,12,40]. However, these systematic reviews all included studies with self-report data, which carry a critically high risk of recall bias.…”

“…They also found that the risk of lung cancer was over 10 times greater in the first 5 years following TB diagnosis, remaining elevated for more than 20 years after TB [39]. More recent systematic reviews found similar results in pulmonary [11,40] and non-pulmonary cancers [12] post-TB. In these studies, pooled risk of lung cancer ranged from 1.96 to 2.17 [11,12,40].…”

“…Our main strength was that we provided pooled risk estimates for both pulmonary and non-pulmonary cancers from diverse populations with various effect estimates and cancer risk over time. Compared to other systematic reviews on TB and cancer [11,12,39,40], we used strict inclusion criteria for the diagnosis of both TB and cancer, requiring either clinical or health administrative diagnoses. For our pooled risk analyses calculated with SIRs, we chose studies with more robust diagnostic criteria for TB, with two studies reporting 47% [32,33] and 58% [30] culture-confirmed TB, and one study requiring medical database codes plus prescription of anti-TB medication [28].…”

The relationship between previous pulmonary tuberculosis and risk of lung cancer in the future

“…There is evidence in a literature using Meta-analysis indicated that Tuberculosis diagnosed at a young age is a risk factor for lung cancer, regardless of smoking history or other underlying disorders. This trend was more obvious among patients from high TB burden countries [ 12 ].…”

“…This has also become another important reason for the susceptibility of lung cancer in pulmonary tuberculosis patients with a history of smoking. Severe lung tissue damage mediated by the TB susceptibility locus sst1 is more significant in the occurrence of lung cancer caused by chronic TB infection [ 12 ]. Camilo Molina-Romero stated that Mycobacterium tuberculosis DNA can integrate into bronchial epithelial cells and induce lung neoplastic transformation [ 95 ].…”