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Meta-Analysis
. 2022 Jul 27;31(165):220025.
doi: 10.1183/16000617.0025-2022. Print 2022 Sep 30.

Lung cancer occurrence after an episode of tuberculosis: a systematic review and meta-analysis

Javier Cabrera-Sanchez  1 , Vicente Cuba  2 , Victor Vega  3 , Patrick Van der Stuyft  4 , Larissa Otero  2   3
Affiliations
Meta-Analysis

Lung cancer occurrence after an episode of tuberculosis: a systematic review and meta-analysis

Javier Cabrera-Sanchez et al. Eur Respir Rev. .

Abstract

Introduction: 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.

Methods: 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).

Results: 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, I2=81%; five studies) and OR 1.74 (95% CI 1.42-2.13, I2=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.

Conclusion: 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.

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Conflict of interest statement

Conflict of interest: The authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flowchart. LILACS: Latin American and Caribbean Health Sciences Literature; SciELO: Scientific Electronic Library Online.
FIGURE 2
FIGURE 2
Forest plots showing the association between tuberculosis and subsequent lung cancer diagnosis in studies with adjustment for age and any assessment of smoking (model 2). HR: hazard ratio.
FIGURE 3
FIGURE 3
Forest plots showing the association between tuberculosis and subsequent lung cancer diagnosis in studies with adjustment for age and quantitatively assessed smoking (model 3). HR: hazard ratio.
See this image and copyright information in PMC

References

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