title: Concomitant active tuberculosis prolongs survival in non-small cell lung cancer: a study in a tuberculosis-endemic country.
abstract: BACKGROUND
  Adjuvant tumor cell vaccine with chemotherapy against non-small cell lung cancer (NSCLC) shows limited clinical response. Whether it provokes effective cellular immunity in tumor microenvironment is questionable. Concomitant active tuberculosis in NSCLC (TBLC) resembles locoregional immunotherapy of tumor cell vaccine; thus, maximally enriches effective anti-tumor immunity. This study compares the survival and immunological cell profile in TBLC over NSCLC alone.
  
  
  METHODS
  Retrospective review of NSCLC patients within 1-year-period of 2007 and follow-up till 2010.
  
  
  RESULTS
  A total 276 NSCLC patients were included. The median survival of TBLC is longer than those of NSCLC alone (11.6 vs. 8.8 month, p<0.01). Active tuberculosis is an independent predictor of better survival with HR of 0.68 (95% CI, 0.48 ~ 0.97). Squamous cell carcinoma (SCC) (55.8 vs. 31.7%, p<0.01) is a significant risk factor for NSCLC with active TB. The median survival of SCC with active tuberculosis is significantly longer than adenocarcinoma or undetermined NSCLC with TB (14.2 vs. 6.6 and 2.8 months, p<0.05). Active tuberculosis in SCC increases the expression of CD3 (46.4 ± 24.8 vs. 24.0 ± 16.0, p<0.05), CXCR3 (35.1 ± 16.4 vs. 19.2 ± 13.3, p<0.01) and IP-10 (63.5 ± 21.9 vs. 35.5 ± 21.0, p<0.01), while expression of FOXP3 is decreased (3.5 ± 0.5 vs. 13.3 ± 3.7 p<0.05, p<0.05). Survival of SCC with high expression of CD3 (12.1 vs. 3.6 month, p<0.05) and CXCR3 (12.1 vs. 4.4 month, p<0.05) is longer than that with low expression.
  
  
  CONCLUSIONS
  Active tuberculosis in NSCLC shows better survival outcome. The effective T lymphocyte infiltration in tumor possibly underlies the mechanism. Locoregional immunotherapy of tumor cell vaccine may deserve further researches.
authors.affiliation: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Chih-Hsi
authors.initials: CH
authors.lastname: Kuo
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lo
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Chung
authors.forename: Kang-Yun
authors.initials: KY
authors.lastname: Lee
authors.forename: Shu-Min
authors.initials: SM
authors.lastname: Lin
authors.forename: Chun-Hua
authors.initials: CH
authors.lastname: Wang
authors.forename: Chih-Chen
authors.initials: CC
authors.lastname: Heh
authors.forename: Hao-Cheng
authors.initials: HC
authors.lastname: Chen
authors.forename: Han-Pin
authors.initials: HP
authors.lastname: Kuo
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000276:immunology / Q000401:mortality; D000368:Aged; D017252:CD3 Complex / Q000378:metabolism; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000276:immunology / Q000401:mortality; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality; D054357:Chemokine CXCL10 / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications* / Q000276:immunology / Q000401:mortality; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology; D008297:Male; D008875:Middle Aged; D054367:Receptors, CXCR3 / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology; D013624:Taiwan / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000276:immunology
chemical_list: D017252:CD3 Complex; C114753:CXCL10 protein, human; C515187:CXCR3 protein, human; D054357:Chemokine CXCL10; D054367:Receptors, CXCR3