Epidemiology And Risk Factors Of Pulmonary Tuberculosis Combined With Lung Cancer In Guangzhou

Background: Tuberculosis combined with lung cancer(TB-LC)refers to the disease phenomenon of tuberculosis combined with lung cancer.Both active tuberculosis and old tuberculosis can be combined with lung cancer.Pulmonary tuberculosis and lung cancer often overlap in areas with high prevalence,and the situation of pulmonary tuberculosis combined with lung cancer has gradually attracted attention.However,most domestic studies are mainly clinical analysis,lacking epidemiological data based on large samples,and unable to provide systematic epidemiological characteristics of pulmonary tuberculosis combined with lung cancer,and unable to systematically answer questions such as whether pulmonary tuberculosis is a high-risk factor for lung cancer.Objective: By obtaining the epidemiological characteristics and correlation of pulmonary tuberculosis complicated with lung cancer in Guangzhou area,this study provides a basis for the formulation of lung cancer screening and tumor intervention strategies in tuberculosis population.Methods:(1)Epidemiological investigation of pulmonary tuberculosis patients with lung cancer in Guangzhou.From January 2011 to December 2020,tuberculosis patients registered and reported in Guangzhou tuberculosis network were selected as the source population,the basic information,diagnosis,treatment,prognosis and survival factors of patients with pulmonary tuberculosis complicated with lung cancer in Guangzhou in the past 10 years were obtained by cross-matching with the cancer database and the cause of death database of Guangzhou.(2)The incidence of lung cancer in pulmonary tuberculosis patients was followed up for five years.Patients with pulmonary tuberculosis registered from2011 to 2015 were selected to observe the incidence and incidence density of lung cancer after at least 5 years of follow-up.The incidence ratio of lung cancer among pulmonary tuberculosis patients was compared with that of general population in Guangzhou.(3)Nested case-control study on risk factors of lung cancer in patients with pulmonary tuberculosis in Guangzhou.The patients with lung cancer who were first diagnosed with pulmonary tuberculosis were taken as the case group.Among the patients with pulmonary tuberculosis who were registered and diagnosed at the same time,1:1 random matching was conducted to establish a nested case-control study according to age,sex and the pulmonary tuberculosis with lung cancer case group,to explore the characteristic differences between the pulmonary tuberculosis with lung cancer group and the common pulmonary tuberculosis group and the risk factors related to the incidence of lung cancer.Kaplan-Meier methods were used to assess survival and prognosis in case group and control group.Cox regression models and hazard ratio(HR)were used to assess risk factors associated with survival.Results:(1)A total of 98870 cases of pulmonary tuberculosis were reported in Guangzhou from 2011 to 2020,among which 1178 cases(1.19%)were complicated with lung cancer.In terms of the characteristics of lung cancer,adenocarcinoma and squamous cell carcinoma were the main types of lung cancer,and stage Ⅳ and stageⅢ accounted for the most.86.45% of patients with pulmonary cavity and lung cancer occurred in the same pulmonary lobe(217/251),73.85% of patients with pulmonary cavity and lung cancer lesions occurred in the same location(48/65).In terms of the diagnostic interval,53.9% of the patients were diagnosed with pulmonary tuberculosis and lung cancer less than one year apart,and 88.35% of the patients with pulmonary tuberculosis were diagnosed with lung cancer within 1-5years.Male patients,incomplete treatment,positive etiological type,smoking,stage IV stage of lung cancer,and less than one year interval between pulmonary tuberculosis and lung cancer increased the risk of death in patients with pulmonary tuberculosis and lung cancer.(2)811 patients with pulmonary tuberculosis reported the incidence of lung cancer during the follow-up period.The incidence density of lung cancer in pulmonary tuberculosis patients was 135.22/100,000 person per year,which was significantly higher than the cumulative incidence of lung cancer in the general population of 60.04/10w(52836/8800.68w)during the same period.The ratio of lung cancer incidence in patients with pulmonary tuberculosis to that in the general population in Guangzhou was 2.26.(3)Sputum smear positive(OR=1.709,95%CI:1.403-2.083),severe tuberculosis(OR=1.427,95%CI:1.000-2.037;Retreatment of pulmonary tuberculosis(OR=1.203)was a risk factor for developing lung cancer in patients with pulmonary tuberculosis.In terms of survival and prognosis,864(73.34%)patients with lung cancer died,and the risk of death in the TB-LC group was 7.124 times higher than that in the TB group alone(95%CI:5.724-8.867,P < 0.001).Conclusion: The incidence rate of lung cancer in patients with tuberculosis in Guangzhou is higher than that in the general population at the same time,and the risk of lung cancer is higher in patients with tuberculosis.Lung adenocarcinoma is the main pathological type of pulmonary tuberculosis patients with lung cancer.Patients with pulmonary tuberculosis complicated with lung cancer have developed to an advanced stage at the time of diagnosis of lung cancer,which seriously affects the survival and prognosis of patients.Elderly people,smoking,incomplete treatment of standardized tuberculosis,and positive etiology of tuberculosis are high-risk factors for the incidence and death of pulmonary tuberculosis complicated with lung cancer.Follow-up and health monitoring should be maintained in 5 years for elderly patients with smoking history,incomplete treatment and etiological positive tuberculosis,and timely screening for lung cancer.Establishing bidirectional screening strategy in patients with pulmonary tuberculosis and lung cancer is of positive significance for early detection and precise prevention and control of these two diseases.