Solid-organ malignancy as a risk factor for tuberculosis.
OBJECTIVE
The effective control of tuberculosis (TB) requires that people at high risk for the reactivation of TB are identified. Haematological malignancy has been shown to be a risk factor for the development of TB, either through immune suppression by the tumour or through the effects of chemotherapy. This study assessed the hypothesis that solid-organ malignancy is a risk factor for the development of TB.


METHODS
A retrospective cohort study was performed to determine the incidence of TB in patients with solid-organ malignancy and in control subjects without malignancy. Risk factors for the development of TB among patients with cancer were also assessed.


RESULTS
The study recruited 1809 cases with cancer and 1809 control subjects and followed them for 3 years. The incidence of active TB per 1000 person-years was 3.07 in patients with cancer and 0.77 in controls (P = 0.009). Compared with the control group, patients with cancer had an increased risk of developing TB (incidence rate ratio (IRR) 4.69, 95% CI: 1.52-14.46). Proportional hazards regression analysis showed that the risk factors for development of TB were chronic renal failure (IRR 9.91, 95% CI: 1.17-83.60), old healed TB on CXR (IRR 45.05, 95% CI: 5.74-353.88), and anticancer chemotherapy (IRR 4.32, 95% CI: 1.10-16.89). An interaction between old healed TB and anticancer chemotherapy was observed.


CONCLUSIONS
These findings indicate that immune suppression by cancer or by anticancer chemotherapy increases vulnerability to reactivation of TB, especially in cancer patients with old healed TB.
Kim
Hye-Ryoun
HR
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Jongno-gu, Seoul 110-744, Korea.
Hwang
Seung Sik
SS
Ro
Yun Kwan
YK
Jeon
Chang Ho
CH
Ha
Dong Yeob
DY
Park
Sung Joon
SJ
Lee
Chang-Hoon
CH
Lee
Sang-Min
SM
Yoo
Chul-Gyu
CG
Kim
Young Whan
YW
Han
Sung Koo
SK
Shim
Young-Soo
YS
Yim
Jae-Joon
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D004358:Drug Therapy; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D008113:Liver Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*
D000970:Antineoplastic Agents