Plasma NLRC4 and NLRP3 as potential diagnostic biomarkers for non-small cell lung cancer in pulmonary tuberculosis

Background Differentiating NSCLC from PTB remains a clinical challenge, especially when new or enlarging lung lesions appear during tuberculosis treatment. This often leads to missed surgical opportunities and delays in cancer management. Accurately identifying NSCLC within the context of PTB is essential for timely intervention. Methods Seventy-five participants were recruited, including 25 with both PTB and NSCLC (NSCLC group), 40 age- and gender-matched PTB patients (control group), and 10 healthy volunteers. Plasma NLRC4 and NLRP3 levels were analyzed using ELISA. Statistical analyses, including t-tests, ANOVA, regression, and ROC analyses, were performed to assess biomarker levels and diagnostic utility. Results Plasma levels of NLRC4 and NLRP3 in the NSCLC group were significantly higher than those in the healthy volunteer group (1451.17 ± 262.92 pg/mL vs. 1161.03 ± 137.26 pg/mL, p = 0.0020; 199.91 ± 56.29 pg/mL vs. 125.13 ± 25.58 pg/mL, p = 0.0003), but significantly lower than those in the control group (1645.67 ± 229.01 pg/mL, p = 0.0034; 241.88 ± 67.24 pg/mL, p = 0.0016). In patients with concomitant PTB and NSCLC, NLRC4 levels demonstrated a significant positive correlation with age (p = 0.0139), while NLRP3 levels exhibited a significant positive correlation with vitamin B levels (p = 0.0057). The combination of NLRC4 and NLRP3 exhibited the most promising diagnostic value for NSCLC (area under the curve [AUC]: 0.769), particularly in Stage I-II (AUC: 0.718), adenocarcinoma (AUC: 0.785), and individuals aged ≤ 60 years (AUC: 0.848). Conclusions Plasma NLRC4 and NLRP3 levels are promising biomarkers for distinguishing NSCLC in TB patients, with their combined use enhancing diagnostic accuracy in specific patient groups.