Shortened survival of lung cancer patients initially presenting with pulmonary tuberculosis

It has been reported that the incidence of lung cancer is higher in patients with pulmonary tuberculosis (TB). However, there is little information on the survival and clinical characteristics of these patients. We retrospectively reviewed the medical records of patients with coexisting pulmonary TB and lung cancer covering a period from 1988 to 1994. There were 31 such patients among a total of 3928 lung cancers diagnosed. Lung cancer patients had an increased risk of active pulmonary TB in comparison with the general population in Taiwan. Diabetes mellitus (DM) was found in 37.5% of patients who were diagnosed as having active pulmonary TB within 2 years before, or concurrent with, the diagnosis of lung cancer. However, none of the patients who had developed lung cancer before TB had a history of DM. Epidermoid carcinoma accounted for 64.5% of these cases. The patients who had developed active pulmonary TB before, or concurrently with, the diagnosis of lung cancer survived shorter than those who did not have pulmonary TB at diagnosis of lung cancer (P=0.007). Survival from diagnosis of pulmonary TB was longer in patients who developed the disease earlier than lung cancer (P=0.046). Survival from the time of diagnosis of lung cancer was significantly longer in patients who developed cancer earlier than active pulmonary TB (P=0.0048), those without DM (P=0.0132), those with an early tumor stage (P=0.002), and those given specific cancer treatment (P=0.0001). It is concluded that survival is shorter in lung cancer patients who present initially with active TB than in those who do not have TB.