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Original Article
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Korean J Intern Med. 2026;41(4):721-730. Published online July 1, 2026.
DOI: https://doi.org/10.3904/kjim.2025.289
- Restrictive lung function and smoking increase lung cancer risk in tuberculosis survivors: a cohort study
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Yun-Gyoo Lee1
, Hyun-Il Gil2, Dayeon Seo3, Bo-Guen Kim1, Hyunjoo Lee4, Young Hwan Kim5, Heerim Nam6, Soo-Youn Ham7, Du-Young Kang8, Jae-Uk Song2
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1Division of Hematology & Medical Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
3Sungkyunkwan University School of Medicine, Suwon, Korea
4Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
5Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
6Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
7Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
8Department of Thoracic & Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Corresponding author: Yun-Gyoo Lee ,Tel: +82-2-2001-1859, Email: yungyoolee@gmail.com
Jae-Uk Song ,Tel: +82-2-2001-1859, Email: khfever76@gmail.com
- Received: August 24, 2025; Revised: November 8, 2025 Accepted: November 14, 2025.
- Abstract
- Background/Aims
Individuals with prior tuberculosis (TB) infection represent a high-risk group for lung cancer due to chronic pulmonary damage. Although associations between TB and lung cancer have been established, this study aimed to explore specific risk factors of lung cancer development in TB survivors.
Methods
Data from 9,734 TB survivors within the Kangbuk Samsung Cohort Study (2011–2021) were analyzed. Pulmonary function was assessed by spirometry and classified as normal, restrictive, or obstructive. Multivariable Cox proportional hazard models were used to evaluate the relationships among lung function, smoking, alcohol consumption, comorbidities, and lung cancer incidence.
Results
Participants were mostly male (65.4%), with an average age of 41.2 years. Over a median follow-up of 12.3 years, 22 lung cancer cases were identified. Univariate analysis revealed significant associations with restrictive (hazard ratio [HR] 2.58, 95% CI 1.00–6.65; p = 0.050) and obstructive (HR 6.48, 95% CI 2.05–20.43; p < 0.001) lung function, age (HR 2.35 per 5-year; p < 0.001), heavy smoking (HR 6.62; p < 0.001), alcohol (HR 3.05; p = 0.019), and diabetes (HR 6.40; p = 0.003). In multivariable models, restrictive lung function (HR 2.94, 95% CI 1.00–8.65; p = 0.050), age (HR 1.73; p < 0.001), and heavy smoking (HR 4.09; p = 0.010) persisted as independent risk factors. Obstructive lung function initially showed a strong association but was not significant after adjusting for covariates, indicating confounding.
Conclusions
Restrictive lung function, likely indicative of post-TB fibrotic changes, heavy smoking, and older age significantly predict lung cancer development in TB survivors. These results highlight the need for surveillance using spirometry for TB survivors.
Keywords :Tuberculosis; Lung cancer; Respiratory function tests
