Does Every Necrotizing Granulomatous Inflammation Identified by NSCLC Resection Material Require Treatment?

Area of Science:

• Pulmonology
• Oncology
• Infectious Diseases

Background:

• Lung cancer and tuberculosis (TB) are significant global health issues with complex interactions.
• While TB increases lung cancer risk, the converse relationship, particularly in resectable non-small cell lung cancer (NSCLC), requires further investigation.
• The presence of necrotizing granulomatous inflammation (NGI) in NSCLC specimens raises questions about potential TB development.

Purpose of the Study:

• To investigate the incidence of tuberculosis (TB) in patients with resectable non-small cell lung cancer (NSCLC) following surgery.
• To assess the necessity of anti-TB treatment in NSCLC patients with necrotizing granulomatous inflammation (NGI) in resected specimens.

Main Methods:

• Retrospective cohort study involving 1027 patients who underwent NSCLC surgery between 2009 and 2013 at three university hospitals.
• Patient records were reviewed for NGI in resected specimens, alongside demographic data, tumor characteristics, surgical details, and TB history.
• Development of TB was monitored for two years post-surgery.

Main Results:

• Of 1027 patients, 48 had NGI. The majority were squamous cell carcinoma, treated with lobectomy.
• No cases of active tuberculosis were diagnosed within the two-year postoperative follow-up period among the study population.
• Anti-TB treatment decisions were primarily based on radiological findings and physician experience, not strongly linked to patient or tumor factors.

Conclusions:

• The presence of NGI in resected NSCLC specimens does not automatically indicate a need for anti-TB treatment.
• No increased risk of developing TB was observed in NSCLC patients with NGI during the follow-up period.
• These findings suggest a potential shift in clinical management regarding anti-TB treatment in this patient group.