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

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.

Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis

“…A review published in 2009 estimated a relative risk of 2.9 (95% CI 1.6–5.3) after controlling for lifetime tobacco smoke exposure, 18 a relative risk of 1.69 (95% CI 1.46–1.95) in a 2020 review, 13 a pooled summary estimate of 1.85 (95% CI 1.52–2.25) in a 2021 review, 16 a relative risk of 2.17 (95% CI 1.83–2.57) in a 2022 review, 14 an odds ratio of 2.09 (95% CI 1.62–2.69) in another 2022 review, 15 and finally an odds ratio of 1.74 (95% CI 1.42–2.13) in the most recent review after adjusting for age and smoking. 17 …”

“…In fact, after successful completion of PTB treatment, many individuals develop chronic respiratory complications such as abnormal lung function, 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 bronchiectasis, 11 , 12 and lung cancer. 13 , 14 , 15 , 16 , 17 , 18 These complications may result in disability and reduced health-related quality of life.…”

“… 19 While previous systematic reviews have assessed the prevalence of respiratory impairment and certain respiratory complications after treatment of PTB, broader inclusion criteria were commonly used, such as including participants with self-reported TB, extra-pulmonary TB, inactive TB, and even latent TB. 3 , 4 , 5 , 6 , 13 , 14 , 15 , 16 , 17 , 18 A previous systematic review demonstrated higher odds of developing lung cancer post-TB when studies of self-reported TB were excluded (OR 2.26 compared to 2.09). 15 Therefore, it is unclear if the estimation of the occurrence of respiratory impairment and complications would be different with more stringent PTB inclusion criteria.…”

Anticancer Activity of Anti-Tubercular Compound(s) Designed on Pyrrolyl Benzohydrazine Scaffolds: A Repurposing Study

“…There is a plethora of evidence that shows the correlation of tuberculosis with lung cancer, and tuberculosis is considered an important risk factor for lung cancer [48][49][50]. Hence, targeting lung cancer with anti-tubercular compound(s) seems to be an appealing strategy and could provide a boon to a tuberculosis-infected lung cancer patient in the future.…”

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

“…Patients with LC may exhibit deficiencies in cell-mediated immunity as either a direct effect or an indirect effect related to chemotherapy and consequently developed TB [6,27]. Some studies also reported the development of TB in LC patients [28][29][30]. So, a significant level of controversies still exists regarding the association of TB and LC which need to be explored.…”