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

Background: 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.