Abstract:

Objective: To analyze the clinical characteristics and survival prognosis of patients with lung cancer concurrent with drug-resistant pulmonary tuberculosis (LC+DR-PTB), and to explore the factors influencing their prognosis. Methods: A retrospective cohort study was conducted, including 223 patients admitted to Xi’an Chest Hospital from January 2020 to March 2025. They were divided into three groups: the lung cancer group (LC group, n=126), the lung cancer concurrent with drug-sensitive pulmonary tuberculosis group (LC+DS-PTB group, n=82), and the lung cancer concurrent with drug-resistant pulmonary tuberculosis group (LC+DR-PTB group, n=15). Clinical characteristics of those patients were collected, and conduct matching using the propensity score matching (PSM) method, after matching, there were 54 cases in the LC group, 51 cases in the LC+DS-PTB group, and 15 cases in the LC+DR-PTB group. The survival curves were plotted using the Kaplan-Meier method, and the survival differences between groups were compared using the log-rank test. The Cox proportional hazards regression model was used to analyze the prognostic factors. Results: Comparison of baseline clinical characteristics before PSM: compared with the LC group, the LC+DR-PTB group had poorer Eastern Cooperative Oncology Group performance status (ECOG)(1 (1, 1) vs. 1 (1, 2); U=521.500, P=0.001), lower body mass index (BMI)((22.40±3.54) kg/m² vs. (19.84±4.23) kg/m²; t=2.610, P=0.010), and a higher proportion of underlying lung diseases (7.9% (10/126) vs. 33.3% (5/15); Fisher’s exact test, P=0.011). After PSM, the median overall survival (mOS) was 60.0 months in the LC group, 36.0 months in the LC+DS-PTB group, and 30.3 months in the LC+DR-PTB group, with a statistically significant difference (χ²=6.019, P=0.049). The multivariate Cox proportional hazards regression analysis showed that coexisting sensitive pulmonary tuberculosis (HR (95%CI): 3.288 (1.448-7.466)) and coexisting drug-resistant pulmonary tuberculosis (HR (95%CI): 4.446 (1.500-13.176)), age ≥65 (HR (95%CI): 2.957 (1.100-7.946)) and underlying diseases (HR (95%CI): 2.428 (1.107-5.326)) were independent risk factors for overall survival (OS) of lung cancer; surgical treatment (HR (95%CI): 0.162 (0.034-0.762)) was an independent protective factor for OS of lung cancer. In the LC+DR-PTB group, rifampicin resistance pulmonary tuberculosis was the most common (40.0%, 6/15), with a treatment success rate of only 33.3% (5/15). The retreatment rate was 46.7% (7/15), which was significantly higher than 13.7% (7/51) in the LC+DS-PTB group (Fisher’s exact test, P=0.011). The diagnostic delay was 23 (6, 33) days, significantly longer than 6 (4, 17) days in the LC+DS-PTB group (U=212.500, P=0.046). The treatment delay was 6 (3, 12) days, significantly longer than 1 (0, 5) days in the LC+DS-PTB group (U=152.500, P=0.006). Conclusion: LC+DR-PTB patients have complex clinical features, often presenting with poorer baseline ECOG scores and BMI, and often accompanied by underlying pulmonary diseases. The diagnosis and treatment of active pulmonary tuberculosis often have obvious delay, and the success rate of tuberculosis treatment is low, and the retreatment rate is high. Comorbidity status is an independent risk factor affecting the overall survival of lung cancer patients and has a poor prognosis.

Key words: Lung neoplasms, Tuberculosis, pulmonary, Drug resistance, Comorbidity, Prognosis