Clinical Characteristics and Prognosis of Non-Small Cell Lung Cancer with Coexisting Pulmonary Tuberculosis: A Retrospective Matched-Cohort Study

Jing Zheng,1,2,* Haoran Xie,3,* Guocan Yu,1,2 Likui Fang,1,2 Min Gao,1,2 Fangming Zhong,1,2 Bo Ye,3 Wenfeng Yu1,2 1Department of Tuberculosis, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, 310003, People’s Republic of China; 2Department of Thoracic Surgery, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, 310003, People’s Republic of China; 3The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, 310003, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenfeng Yu, Email ywf1078@163.comBackground: Pulmonary tuberculosis (PTB) may coexist with non-small cell lung cancer (NSCLC), yet the clinical implications of this coexistence, including its prognostic impact, remain understudied.Methods: We performed a retrospective 1:1 matched cohort study of 132 patients (66 PTB-NSCLC cases and 66 NSCLC-only controls) diagnosed between 2017 and 2023. Cases and controls were matched on age (± 5 years) and TNM stage. Kaplan–Meier analysis evaluated survival differences, with hazard ratios derived from Cox proportional hazards regression.Results: Between 2017 and 2023, patients with simultaneously diagnosed PTB and NSCLC (PTB-NSCLC) cases constituted approximately 4.7% of all diagnosed NSCLC patients. PTB-NSCLC patients exhibited higher erythrocyte sedimentation rates (p = 0.002) and lower serum albumin levels (p = 0.032) than controls. Elevated erythrocyte sedimentation rate was associated with poor survival in univariate analysis (p = 0.037), while a high modified Glasgow Prognostic Score (mGPS) remained an independent predictor of adverse outcomes in multivariable analysis (HR: 2.55, 95% CI: 1.12– 5.84; p = 0.026). Kaplan-Meier analysis revealed that patients with PTB-NSCLC coexistence had significantly worse overall survival compared to matched controls (median OS: 32 vs 72 months; HR: 2.879, 95% CI: 1.728– 4.797; p < 0.001). Furthermore, in multivariable analysis, surgical intervention was associated with significantly improved survival (HR: 0.34, 95% CI: 0.14– 0.81; p = 0.015).Conclusion: PTB-NSCLC confers worse survival outcomes. The mGPS provides independent prognostic value, while surgical intervention was associated with a significant survival benefit, highlighting the importance of integrated management.Keywords: non-small cell lung cancer, pulmonary tuberculosis, comorbidity, prognosis