Increased Lung Cancer Risk and Associated Risk Factors in Tuberculosis Survivors: A Korean Population-Based Study

Abstract

Background: Few studies have comprehensively evaluated the risk of lung cancer in tuberculosis survivors with consideration of smoking status and chronic obstructive pulmonary disease (COPD). Furthermore, little is known about lung cancer risk factors in tuberculosis survivors.

Methods: This population-based cohort study enrolled tuberculosis survivors (n = 75 467) between 2010 and 2017 and 1:1 age- and sex-matched controls. Subjects were followed up for 1 year from the date of tuberculosis diagnosis to the date of the incident lung cancer, death, or December 2018, whichever came first. The risk of lung cancer was evaluated according to smoking and COPD status. We also evaluated the risk factors for lung cancer and developed an individualized lung cancer prediction model for tuberculosis survivors.

Results: During a median follow-up duration of 4.8 years, the incident lung cancer risk was 1.72-fold higher in tuberculosis survivors than in the controls. Among tuberculosis survivors, those who were current smokers with ≥20 pack-years showed the highest risk of lung cancer (adjusted hazard ratio, 6.78) compared with never-smoker, non-tuberculosis-infected controls. tuberculosis survivors with COPD had a higher risk (2.43) than non-COPD, non-tuberculosis-infected controls. Risk factors for lung cancer in tuberculosis survivors were pulmonary tuberculosis, age >60 years, smoking, and the presence of COPD or asthma. The individualized lung cancer risk model showed good discrimination (concordance statistic = 0.827).

Conclusions: Previous tuberculosis infection is an independent risk factor regardless of smoking status or amount and COPD. Closer monitoring of tuberculosis survivors, especially heavy smokers or those with COPD, is needed for early lung cancer diagnosis.

Keywords: chronic obstructive pulmonary disease; lung cancer; risk factor; smoking; tuberculosis.

Figure 1.

Cumulative incidence probability of lung cancer in tuberculosis survivors versus matched controls.

Figure 2.

Forest plot of lung cancer incidence by patient subgroups divided by smoking status, chronic obstructive pulmonary disease (COPD), and the presence of tuberculosis history. Abbreviations: CI, confidence interval; HR, hazard ratio.

Figure 3.

A, Cumulative incidence probability of lung cancer by presence of tuberculosis infection and smoking history. B, Cumulative incidence probability of lung cancer by the presence of tuberculosis infection and chronic obstructive pulmonary disease (COPD).

Figure 4.

A, Nomogram for the prediction model of 5-year lung cancer probability. B, The 5-year incidence probability of lung cancer development is based on the total score of the lung cancer prediction model. Abbreviation: COPD, chronic obstructive pulmonary disease.