Tuberculosis and subsequent risk of lung cancer In Xuanwei, China

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, USA.
International Journal of Cancer (Impact Factor: 5.09). 03/2009; 124(5):1183-7. DOI: 10.1002/ijc.24042
Source: PubMed


Tobacco and indoor air pollution from smoky coal are major causes of lung cancer in rural Xuanwei County, China. Tuberculosis has been suggested to increase lung cancer risk, but data from prior studies are limited. We conducted an analysis of data from a retrospective cohort study of 42,422 farmers in Xuanwei. In 1992, interviewers administered a standardized questionnaire that included lifetime medical history, including tuberculosis. Subjects were followed from 1976, with deaths from lung cancer ascertained through 1996. We used proportional hazards regression to assess the association between tuberculosis and subsequent lung cancer mortality. Tuberculosis was reported by 246 subjects (0.6%), and 2,459 (5.8%) died from lung cancer during follow-up. Lung cancer mortality was substantially higher in subjects with tuberculosis than in those without (25 vs. 3.1 per 1,000 person-years). The association was especially pronounced in the first 5 years after tuberculosis diagnosis (hazard ratios [HRs] ranging 6.7-13) but remained strong 5-9.9 years (HR 3.4, 95% CI 1.3-9.1) and 10+ years (HR 3.0, 95% CI 1.3-7.3) after tuberculosis. These associations were similar among men and women and among smoky coal users (70.5% of subjects). Adjustment for demographic characteristics, lung disease and tobacco use did not affect results. In Xuanwei, China, tuberculosis is an important risk factor for lung cancer. The increased lung cancer risk, persisting years after a tuberculosis diagnosis, could reflect the effects of chronic pulmonary inflammation and scarring arising from tuberculosis.

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Available from: Ruth Pfeiffer, Dec 22, 2014
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    • "However, caseous granulomas, tissue liquefaction, and cavity formation in lungs of infected patients often result in longterm deficits, such as impaired pulmonary function (Maguire et al, 2009). In addition, tuberculosis has been associated with subsequent risk of lung cancers (Pasipanodya et al, 2007; Engels et al, 2009). Although the etiological relationship between the two diseases is unknown, increased risk is consistently shown by population-based studies (Wu et al, 2011a; Yu et al, 2011), suggesting that physicians should be aware of lung cancers in patients with prior tuberculosis infections. "
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    ABSTRACT: Background: In addition to lung cancers, tuberculosis infections have been associated with increased risk of non-pulmonary malignancies in case reports. Our population-based study employed standardized incidence ratios (SIRs) to systemically survey non-pulmonary cancer risks after tuberculosis infections. Methods: Data of patients who had newly diagnosed tuberculosis, were aged 20 years or older, and had no prior cancer or tuberculosis were sampled from the Taiwan National Health Insurance database between 2000 and 2010. SIRs compared cancer incidence in patients with tuberculosis infections to the general population. SIRs of specific cancers were further analyzed with respect to gender and time after tuberculosis infections. Results: After a follow-up period of 28 866 person–years, 530 tuberculosis cases developed cancers compared with 256 cases in the general populations (2.07, 95% confidence interval (CI), 1.90–2.26). The SIR of non-pulmonary malignancies was also increased (1.71, 95% CI, 1.54–1.90). For males, SIRs were increased within 1 year after tuberculosis diagnosis for the following cancers: head and neck, esophageal, colorectal, liver, lung, melanomas, and Hodgkin's disease. SIRs were increased for liver, biliary, lung, and bladder cancers beyond the first year after tuberculosis diagnosis. For females, SIRs were increased for leukemia, esophageal, and lung cancers within the first year, and only for leukemia beyond 1 year post diagnosis. Conclusion: Having found increased risks of several cancers that differ with gender and time after tuberculosis diagnosis, physicians may consider these factors in patients following tuberculosis diagnosis.
    Full-text · Article · May 2013 · British Journal of Cancer
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    • "The potential relationship between pulmonary TB and lung cancer has been a topic of active interest for several decades. At present, it is clear that pulmonary TB increases the risk of lung cancer [3-6], but not all studies agree on its utility as a prognostic factor. Recently, a study indicated that a history of pulmonary TB may be a negative prognostic factor for lung cancer survival in Caucasian patients [7], but Kuo and coworkers [8] suggested that concomitant active prolongs survival in NSCLC. "
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    ABSTRACT: Background Pulmonary tuberculosis (TB) is associated with an increased risk of lung cancer. Our study investigated whether the coexistence of an old pulmonary TB lesion is an independent prognostic factor for lung cancer survival in Chinese non-small cell lung cancer patients. Methods We performed a retrospective review of 782 non-small cell lung cancer patients who underwent surgical resection as their primary treatment in 2006 and were followed for 5 years. The associations between lung cancer survival and the presence of old pulmonary TB lesions were assessed using Cox’s proportional hazard regression analysis adjusted for WHO performance status (PS), age, sex, smoking-status, tumor stage, and surgical approach. Results Sixty-four of the patients had old pulmonary TB lesions. The median survival of squamous cell carcinoma patients with TB was significantly shorter than that of patients without TB (1.7 vs. 3.4 years, p < 0.01). The presence of an old pulmonary TB lesion is an independent predictor of poor survival with a hazard ratio (HR) of 1.72 (95% CI, 1.12–2.64) in the subgroup of squamous cell carcinoma patients studied. Conclusion The presence of an old pulmonary TB lesion may be an important prognostic factor for predicting the survival of squamous cell carcinoma patients.
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