During the study period, 98 consecutive lung cancer patients were diagnosed with lung tuberculosis. Among them, antituberculosis treatment was administered in 47 patients (TB treatment group). The other 51 patients did not receive tuberculosis treatment (TB nontreatment group). The lung cancer control group included 51 age-, sex- and cancer stage-matched patients without TB.
The clinical characteristics of the patients in the three groups (Table 1)
Table 1 Comparison of clinical, laboratory and cancer characteristics among three groups
variable
|
With TB
|
Without TB
|
TB
treatment
|
TB nontreatment
|
P
value
|
Lung cancer
|
P value
|
Demographic
|
|
|
|
|
|
Age, years
|
64.0(55.0-70.0)
|
67.5(64.0-75.0)
|
0.006
|
65.4(60.0-70.0)
|
0.997
|
Male, n (%)
|
45(95.7)
|
43(84.3)
|
0.062
|
43(84.3)
|
1.000
|
BMI (kg/m2)
|
20.8(19.8-21.5)
|
21.0(20.3-21.3)
|
0.710
|
21.9(20.5-23.0)
|
0.022
|
Smoker, n (%)
|
32(68.1)
|
31(60.8)
|
0.451
|
28(54.9)
|
0.547
|
Laboratory
|
|
|
|
|
|
Hypoalbuminemia, n (%)
|
19(40.4)
|
13(25.5)
|
0.350
|
12(23.5)
|
0.818
|
Anemia, n (%)
|
13(27.7)
|
12(23.5)
|
0.639
|
17(33.3)
|
0.272
|
Liver dysfunction, n (%)
|
5(10.6)
|
5(9.8)
|
0.892
|
8(15.7)
|
0.373
|
Renal dysfunction, n (%)
|
11(23.4)
|
10(19.6)
|
0.647
|
12(23.5)
|
0.630
|
ESR elevation, n (%)
|
17(43.6)
|
9(21.4)
|
0.033
|
13(32.5)
|
0.258
|
Cancer
|
|
|
|
|
|
Tumor burden, n (%)
|
44(93.6)
|
43(84.3)
|
0.230
|
42(82.4)
|
0.790
|
Type
|
|
|
|
|
|
Non-small cell, n (%)
|
41(87.1)
|
43(84.3)
|
0.705
|
37(72.6)
|
0.531
|
Small cell, n (%)
|
6(12.8)
|
8(15.7)
|
14(27.5)
|
Stage
|
|
|
|
|
|
I, n (%)
|
0(0)
|
2(3.9)
|
0.663
|
2(3.9)
|
1.000
|
II, n (%)
|
3(6.4)
|
3(5.9)
|
3(5.9)
|
III, n (%)
|
13(27.7)
|
15(29.4)
|
15(29.4)
|
IV, n (%)
|
24(51.1)
|
26(51.0)
|
26(51.0)
|
|
|
|
|
|
|
|
|
|
Hypoalbuminemia was defined as a serum albumin concentration < 35 g/L. Anemia was defined as a hemoglobin level < 120 g/L in women and < 130 g/L in men. Liver dysfunction was defined as the total bilirubin levels ≥50 μmol/L and/or prothrombin time index <50%. Renal dysfunction was defined as serum creatinine ≥ 1.5 mg/dL. ESR (erythrocyte sedimentation rate) elevation was defined as ESR ≥ 100 mm/h
The median ages in the three groups were approximately 65 years. The age of patients in the TB nontreatment group was older than that of the patients in the TB treatment group. Male patients comprised 84%-95% of each group. Compared to the TB nontreatment group, the lung cancer patients had a higher body mass index (BMI).
The laboratory findings, including hypoalbuminemia, anemia, liver and renal dysfunction, were nearly similar among the three groups. However, the erythrocyte sedimentation rate (ESR) in the TB treatment group was higher than that in the TB nontreatment group.
The cancer type and stage were similar among the three groups. Most patients had advanced non-small cell lung cancer and had tumor burdens.
Clinical course and response to anticancer treatments (Table 2, Figure-1)
Table 2 Comparison of anticancer therapies among three groups
variable
|
With TB
|
Without TB
|
TB treatment
n (%)
|
TB nontreatment
n (%)
|
P value
|
Lung cancer, n (%)
|
P
value
|
Chemotherapy regimen
|
|
|
|
|
|
Single agent
|
6(12.8)
|
10(19.6)
|
0.360
|
10(19.6)
|
1.000
|
Two agents
|
41(87.2)
|
41(80.4)
|
41(80.4)
|
Treatment completion rate
|
|
|
|
|
|
Completion
|
27(57.4)
|
29(56.9)
|
0.306
|
40(78.4)
|
0.057
|
Delayed completion
|
7(14.9)
|
4(7.8)
|
4(7.8)
|
Early termination
|
6(12.8)
|
12(23.5)
|
3(5.9)
|
Reduction in dose
|
5(10.6)
|
6(11.8)
|
3(5.9)
|
Active withdrawal
|
2(4.3)
|
0(0)
|
1(2.0)
|
Response
|
|
|
|
|
|
Complete response
|
0(0)
|
0(0)
|
0.061
|
1(2.0)
|
0.001
|
Partial response
|
5(10.6)
|
5(9.8)
|
4(7.8)
|
Stable disease
|
31(66.0)
|
25(49.0)
|
40(78.4)
|
Progressive disease
|
11(23.4)
|
21(41.2)
|
6(11.8)
|
Median survival(weeks)
|
56(26-61)
|
52(32-60)
|
|
57(20-64)
|
|
KPS change
|
|
|
|
|
|
Increase
|
6(12.8)
|
14(27.5)
|
0.388
|
10(19.6)
|
0.645
|
Decrease
|
3(6.4)
|
1(2.0)
|
1(2.0)
|
No change
|
38(80.9)
|
36(70.6)
|
40(78.4)
|
The anticancer chemotherapy regimens and treatment completion rates were similar among the three groups. The response rates were similar between the TB treatment and TB nontreatment groups, although more patients in the TB treatment group were in stable disease. However, the response rate was significantly higher in the lung cancer group compared to the TB nontreatment group. The median survival time and KPS changes were similar among the three groups.
Clinical course and response to antituberculosis treatments (Table 3)
Table 3 Comparison of TB characteristics and therapies
variable
|
TB treatment
n (%)
|
TB nontreatment
n (%)
|
P value
|
Type
|
|
|
|
Active
|
31(66.0)
|
3(5.9)
|
0.000
|
Inactive
|
16(34.0)
|
48(94.1)
|
Laboratory
|
|
|
|
Before cancer diagnosis
|
21(44.7)
|
39(76.5)
|
0.000
|
At the same time
|
19(40.4)
|
12(23.5)
|
During anticancer therapy
|
2(4.3)
|
0(0)
|
After anticancer therapy
|
5(10.6)
|
0(0)
|
Diagnose of TB
Culture proven
Diagnosed clinically
|
18
|
1
|
|
Antituberculosis regime
|
|
|
|
Single agent
|
2(4.3)
|
-
|
|
Two agents
|
10(21.3)
|
-
|
|
≥three agents
|
35(74.4)
|
-
|
|
Treatment completion rate
|
|
|
|
Completion
|
39(83.0)
|
-
|
|
Delayed completion
|
1(2.1)
|
-
|
|
Early termination
|
6(12.8)
|
-
|
|
Reduction in dose
|
1(2.1)
|
-
|
|
Tuberculosis treatment outcome
|
|
|
|
Cure
|
0(0)
|
0
|
0.001
|
Improvement
|
27(57.4)
|
0
|
|
Stabilization
|
14(29.8)
|
44(86.3)
|
|
Deterioration
|
6(12.8)
|
7(13.7)
|
|
Most patients in the TB treatment group (66%) had active TB, with a significantly higher percentage than that in the TB nontreatment group (5.9%). TB was diagnosed at different time points. Most patients in the TB nontreatment group (76.5%) were diagnosed with TB before cancer diagnosis. However, 55.3% of patients in the TB treatment group were newly diagnosed with TB. Most patients in the TB treatment group received multidrug combination therapy (74.4%), completed the TB treatment (83%), and had improved outcomes (57.4%).
Side effects of treatments (Table 4)
Table 4 Comparison of side effects of therapies among three groups
variable
|
With TB
|
Without TB
|
TB treatment
n (%)
|
TB nontreatment
n (%)
|
P
value
|
Lung cancer
n (%)
|
P
value
|
Leukocyte deficiency
|
|
|
|
|
|
Grade 3
|
2(4.3)
|
2(3.9)
|
0.460
|
4(7.8)
|
0.488
|
Grade 4
|
2(4.3)
|
1(2.0)
|
0(0)
|
Thrombocytopenia
|
|
|
|
|
|
Grade 3
|
1(2.1)
|
1(2.0)
|
0.642
|
5(9.8)
|
0.769
|
Grade 4
|
0(0)
|
1(2.0)
|
2(3.9)
|
Renal toxic effects
|
|
|
|
|
|
Grade 3
|
0(0)
|
0(0)
|
0.072
|
0(0)
|
0.843
|
Grade 4
|
0(0)
|
0(0)
|
0(0)
|
Live toxicity
|
|
|
|
|
|
Grade 3
|
3(8.1)
|
2(3.9)
|
0.255
|
0(0)
|
0.377
|
Grade 4
|
0(0)
|
1(2.0)
|
0(0)
|
Gastrointestinal toxicity
|
|
|
|
|
|
Grade 3
|
0(0)
|
1(2.0)
|
0.218
|
1(2.0)
|
0.412
|
Grade 4
|
0(0)
|
0(0)
|
0(0)
|
Cardiac toxic effects
|
8(17.0)
|
6(11.8)
|
0.458
|
7(13.7)
|
0.767
|
Neuropathy
|
0(0)
|
1(2.0)
|
0.335
|
0(0)
|
0.315
|
Severe toxic complications in the three groups were similar. Patients in the TB treatment group did not have more severe toxic complications.