Nontuberculous mycobacterial pulmonary disease and lung cancer: a retrospective case series

The incidence of nontuberculous mycobacterial pulmonary disease (NTM-PD) has increased worldwide. However, the clinical characteristics and optimal management of patients with concomitant lung cancer and NTM-PD remain poorly understood. This retrospective case series aimed to investigate the clinical characteristics, microbiological findings, treatment strategies, and clinical outcomes of patients with lung cancer complicated by NTM-PD.

We retrospectively reviewed the clinical data of 13 patients with concomitant lung cancer and NTM-PD at our institution between January 2020 and January 2025. Demographic characteristics, clinical manifestations, microbiological findings, tumor stage, histological subtype, driver gene alterations, treatment strategies, and clinical outcomes were collected and analyzed. NTM species were identified by metagenomic next-generation sequencing (mNGS).

A total of 13 patients (8 men and 5 women) were included, with a median age of 64 years (interquartile range, 59.5-71.0 years). Adenocarcinoma was the most common histological subtype (n=7). The predominant NTM species were Mycobacterium abscessus (n=4) and the Mycobacterium avium complex (MAC) (n=5). Eleven patients received anti-NTM therapy, whereas two were managed conservatively because their respiratory symptoms improved after anticancer treatment and their pulmonary lesions remained radiologically stable. Individualized treatment sequencing enabled most patients to complete anticancer therapy. Two patients with stage I disease underwent delayed surgery following short-term anti-NTM treatment. At the last follow-up, three patients had died and ten remained alive. The mean follow-up duration was 18.69 months (range, 6-53 months).

Among patients with lung cancer complicated by NTM infection, the predominant species were MAC and Mycobacterium abscessus. No obvious worsening of NTM-PD was observed during concurrent treatment, but NTM infection may delay the timing of surgery for early-stage lung cancer.