Active tuberculosis risk associated with malignancies: an 18-year retrospective cohort study in Korea

Abstract

Background: Active tuberculosis (TB) develops in approximately 10% of people with a latent tuberculosis infection (LTBI). TB guidelines recommend that LTBI screening and treatments target high-risk patients.Malignancies are not universally considered a high-risk factor for active TB. This study aimed to determine the degrees to which active TB risk was associated with various cancers in a Korean population. Methods: This study involved patients aged ≥20 years who were diagnosed with cancer at Ulsan University Hospital (UUH) from January 2000 to December 2014 and individuals who visited UUH for health screening and were age-and sex-matched randomly with cases in a 1:2 ratio. Using retrospective cohort study, the development of bacteriologically confirmed TB (BCTB) within 3 years after enrollment was investigated. The relative risks of BCTB were estimated using incidence rate ratios (IRRs) and a Poisson regression analysis. Results: During the study period, 380 of 34,783 cancer patients and 79 of 69,566 control subjects developed BCTB, yielding respective incidence rates of 535 and 37/100,000 person-years, respectively. In all cancer cases, the IRR of BCTB was 14.30, and especially high rates were associated with the following cancers: esophageal cancer (74.72), multiple myeloma (70.76), lung cancer (50.35), pancreatic cancer (46.04), leukemia (40.45), head and neck cancer (24.60), and lymphoma (22.67). Conclusions: The incidence of active TB was higher in cancer patients than in control subjects. In particular, lung cancer, esophageal cancer, pancreatic cancer, hematologic malignancy and head and neck cancer were identified as high-risk factors for active TB, as indicated by IRRs of 20-75. These findings suggest that patients with high-risk cancers should be targeted for LTBI screening and treatment.

Incidence and Risk of Lung Cancer in Tuberculosis Patients, and Vice Versa: A Literature Review of the Last Decade

“…Another study conducted in Canada reported the increased risk of active TB (aHR = 11.20) after 19 years of follow-up [ 50 ]. One retrospective study which investigated the incidence and risk of clinically diagnosed TB and bacteriologically confirmed TB (BCTB) in LC patients found the BCTB IRR was 50.35 in comparison with control [ 51 ]. One retrospective study in Thailand followed up 18 years and found a cumulative incidence 1.15% for TB in LC patients [ 52 ].…”

“…Furthermore, like COPD, the presence of several baseline chronic inflammatory diseases especially HIV and AIDS may increase the incidence of LC in TB patients, an issue that was not addressed [ 56 ]. On the other hand, previous studies stated that patients with other cancer including oesophageal cancer, pancreatic cancer, hematologic malignancy, and head and neck cancer faced a particularly high risk of developing TB [ 13 , 51 ]. Even histological types of LC, including SmCC and sarcoma, were strongly associated with TB [ 13 ].…”

“…Note: all values of HR, RR, IRR, SIR, and OR were presented as 95% confidential interval (lower and upper). BioMed Research International (BCTB) in LC patients found the BCTB IRR was 50.35 in comparison with control [51]. One retrospective study in Thailand followed up 18 years and found a cumulative incidence 1.15% for TB in LC patients [52].…”

Cancer and tuberculosis: A lethal duo

“…Lung cancer, oesophageal cancer, pancreatic cancer, hematologic malignancy, and head and neck cancer patients are at an increased risk of contracting TB. These patients with high-risk cancers should mainly be targeted for LTBI screening and treatment [1]. The compliance of TB preventive therapy in immunocompromised patients like people living with Human immunodeficiency virus (PLHIV) already on antiretroviral therapy has been demonstrated to be good [11].…”

“…Patients with cancer may have impairments in cell-mediated immunity due to chemotherapy, either directly or indirectly. As a result, many people who have LTBI and cancer develop active tuberculosis [1]. We herein describe one such case report of a patient diagnosed and treated with malignancy, developing tuberculosis later.…”