title: Latent TB infection in newly diagnosed lung cancer patients - A multicenter prospective observational study.
abstract: OBJECTIVE
  Lung cancer and tuberculosis (TB) share common risk factors and are associated with high morbidity and mortality. Coexistence of lung cancer and TB were reported in previous studies, with uncertain pathogenesis. The association between lung cancer and latent TB infection (LTBI) remains to be explored.
  
  
  METHODS
  Newly diagnosed, treatment-naïve lung cancer patients were prospectively enrolled from four referral medical centers in Taiwan. The presence of LTBI was determined by QuantiFERON-TB Gold In-Tube (QFT-GIT). Demographic characteristics and cancer-related factors associated with LTBI were investigated. The survival status was also analyzed according to the status of LTBI.
  
  
  RESULTS
  A total of 340 lung cancer patients were enrolled, including 96 (28.2%) LTBI, 214 (62.9%) non-LTBI, and 30 (8.8%) QFT-GIT results-indeterminate cases. Non-adenocarcinoma cases had higher proportion of LTBI than those of adenocarcinoma, especially in patients with younger age. In multivariate analysis, COPD (OR 2.41, 95% CI 1.25-4.64), fibrocalcified lesions on chest radiogram (OR 2.73, 95% CI 1.45-5.11), and main tumor located in typical TB areas (OR 2.02, 95% CI 1.15-3.55) were independent clinical predictors for LTBI. Kaplan-Meier survival analysis demonstrated patients with indeterminate QFT-GIT results had significantly higher 1-year all-cause mortality than those with LTBI (p<0.001) and non-LTBI (p=0.003). In multivariate analysis, independent predictors for 1-year all-cause mortality included BMI<18.5 (HR 2.09, 95% CI 1.06-4.14, p=0.033), advanced stage of lung cancer (RR 7.76, 95% CI 1.90-31.78, p=0.004), and indeterminate QFT-GIT results (RR 2.40, 95% CI 1.27-4.54, p=0.007).
  
  
  CONCLUSIONS
  More than one-quarter of newly diagnosed lung cancer patients in Taiwan have LTBI. The independent predictors for LTBI include COPD, fibrocalcified lesions on chest radiogram, and main tumor located in typical TB areas. The survival rate is comparable between LTBI and non-LTBI cases. However, indeterminate QFT-GIT result was an independent predictor for all-cause mortality in lung cancer patients.
authors: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Wen-Chien
authors: WC
authors: Fan
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Wen-Ying
authors: WY
authors: Ting
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Ming-Che
authors: MC
authors: Lee
authors: School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
authors: Shiang-Fen
authors: SF
authors: Huang
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Chao-Hua
authors: CH
authors: Chiu
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Shinn-Liang
authors: SL
authors: Lai
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, ROC.
authors: Yuh-Min
authors: YM
authors: Chen
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Jen-Fu
authors: JF
authors: Shih
authors: Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC; Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan, ROC; School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
authors: Ching-Hsiung
authors: CH
authors: Lin
authors: Pulmonary Division, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC; Taipei Medical University, Taipei, Taiwan, ROC.
authors: Shang-Jyh
authors: SJ
authors: Kao
authors: School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC; Divisions of Chest Medicine and Medical Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
authors: Ming-Fang
authors: MF
authors: Wu
authors: Department of Chest Medicine, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
authors: Thomas Chang Yao
authors: TC
authors: Tsao
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Chieh-Hung
authors: CH
authors: Wu
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Infection and Immunity Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Kuang-Yao
authors: KY
authors: Yang
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors: Yu-Chin
authors: YC
authors: Lee
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: jyfeng@vghtpe.gov.tw.
authors: Jia-Yih
authors: JY
authors: Feng
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: wjsu@vghtpe.gov.tw.
authors: Wei-Juin
authors: WJ
authors: Su
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D055985:Latent Tuberculosis / Q000150:complications* / Q000175:diagnosis; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009367:Neoplasm Staging; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
keywords: Adenocarcinoma; COPD; Latent TB infection; Lung cancer; Mortality; Tuberculosis