Pulmonary tuberculosis associated with an increased risk of lung cancer in patients with COPD

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07 October 2021

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Among COPD patients in South Korea, with an intermediate TB burden, a history of pulmonary TB was associated with an increased risk of developing lung cancer, the researchers reported.

“Since the chronic inflammatory process is a potential mechanism for the development of lung cancer in patients with COPD, a history of pulmonary tuberculosis could increase the risk of developing lung cancer in these patients” Hye Yun Park, MARYLAND, Associate Professor in the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, and colleagues wrote in the Annals of the American Thoracic Society. “A history of pulmonary tuberculosis has been identified as a significant co-morbidity of COPD in countries with intermediate to high TB ​​burden. “

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The cohort study included 13,165 people with COPD (mean age, 66.3 years; 48% female) aged 50 to 84 in South Korea. Participants were matched to a COPD-free cohort (n = 34,467; mean age, 65.3 years; 49.5% female) for age, sex, smoking history, and pulmonary TB status to to assess whether the relationship between pulmonary TB and lung cancer risk was different. All participants from both cohorts were followed from 2003 to 2015.

Pulmonary tuberculosis was diagnosed based on the results of the chest x-ray. Incident lung cancer was identified through requests for hospitalization and outpatient visits.

The history of pulmonary TB was 17.8% in the cohort of participants with COPD versus 15.9% of participants without COPD.

During a median follow-up of 7.7 years, there were 430 incident cases of lung cancer among participants with COPD without a history of pulmonary TB (incidence rate, 524 cases per 100,000 person-years) . There were 148 cases of incident lung cancer among participants with COPD and a history of pulmonary tuberculosis (incidence rate, 931 cases per 100,000 person-years).

Among participants with a history of pulmonary TB, the RR for lung cancer was 1.24 (95% CI, 1.03-1.5) compared to participants without a history of pulmonary TB. This association between a history of pulmonary tuberculosis and the development of lung cancer was stronger in participants with COPD who had never smoked. The RR for lung cancer was 0.98 (95% CI, 0.78-1.22) in participants without COPD.

Researchers have not observed any interaction between pulmonary tuberculosis, smoking, and COPD.

“Our study suggests that COPD patients with a history of pulmonary tuberculosis, who never smoke, may benefit from periodic screening or assessment for lung cancer development,” the researchers wrote. “Further studies with larger sample sizes in other settings are needed to confirm our results and to elucidate the mechanical link underlying the complex interaction between pulmonary tuberculosis, COPD and lung cancer. “


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