Top

Published in:

01-12-2019 | Tuberculosis | Original Article

Increased risk of tuberculosis in oral cancer patients in an endemic area: a nationwide population-based study

Authors: Chung-Jen Teng, Leh-Kiong Huon, Yu-Mei Zheng, Chiu-Mei Yeh, Chun-Kuang Tsai, Jin-Hwang Liu, Tzeng-Ji Chen, Chia-Jen Liu, Ya-Ling Lee

Published in: Clinical Oral Investigations | Issue 12/2019

Abstract

Objectives

We investigated the incidence of tuberculosis (TB) in patients with newly diagnosed oral cancer and analyzed the risk factors for TB development and mortality in oral cancer patients.

Materials and methods

We used Taiwan’s National Health Insurance Database to determine the incidence of TB and to analyze the risk factors for TB in patients newly diagnosed with oral cancer. From 2000 to 2011, we identified 40,327 oral cancer patients and the same number of subjects from the general population matched for sex, age, and comorbidities at a 1:1 ratio.

Results

Compared with the matched cohort, oral cancer patients exhibited a higher risk for TB (adjusted hazard ratio (aHR) 2.36, 95% confidence interval (CI) 2.06–2.71). Age ≥ 50 (aHR 1.90, 95% CI 1.57–2.29), being male (aHR 1.98, 95% CI 1.36–2.89), having diabetes mellitus (aHR 1.31, 95% CI 1.05–1.64), alcohol use disorder (aHR 1.42, 95% CI 1.06–1.89), human immunodeficiency virus (HIV) (aHR 8.24, 95% CI 2.05–33.14), chemotherapy (aHR 1.41, 95% CI 1.15–1.72), and radiotherapy for oral cancer (aHR 1.92, 95% CI 1.57–2.36) were identified as independent risk factors for TB in oral cancer patients. Hyperlipidemia was an independent protective factor for TB in oral cancer patients.

Conclusion

Old age, male sex, diabetes mellitus, alcohol use disorder, and HIV were independent risk factors for TB in patients with oral cancer.

Clinical relevance

High-risk oral cancer patients should be regularly screened for TB, especially those in endemic areas.

Lippman SM, Hong WK (2001) Molecular markers of the risk of oral cancer. N Engl J Med 344(17):1323–1326. https://doi.org/10.1056/nejm200104263441710 CrossRefPubMed

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108. https://doi.org/10.3322/caac.21262 CrossRefPubMed

Chiang CJ, Lo WC, Yang YW, You SL, Chen CJ, Lai MS (2016) Incidence and survival of adult cancer patients in Taiwan, 2002–2012. J Formos Med Assoc 115(12):1076–1088. https://doi.org/10.1016/j.jfma.2015.10.011 CrossRefPubMed

Mosel DD, Bauer RL, Lynch DP, Hwang ST (2011) Oral complications in the treatment of cancer patients. Oral Dis 17(6):550–559. https://doi.org/10.1111/j.1601-0825.2011.01788.x CrossRefPubMed

Panghal M, Kaushal V, Kadayan S, Yadav JP (2012) Incidence and risk factors for infection in oral cancer patients undergoing different treatments protocols. BMC Oral Health 12:22. https://doi.org/10.1186/1472-6831-12-22 CrossRefPubMedPubMedCentral

Caroppo D, Russo D, Merolla F, Ilardi G, Del Basso de M, Di Lorenzo P, Varricchio S, Mascolo M, Staibano S (2015) A rare case of coexistence of metastasis from head and neck squamous cell carcinoma and tuberculosis within a neck lymph node. Diagn Pathol 10:197. https://doi.org/10.1186/s13000-015-0430-x CrossRefPubMedPubMedCentral

Chang FY, Chou JH, Chuang JH, Chen YH, Liu DP, Chen CH (2014) Taiwan Tuberculosis Control Report 2013. Centers for Disease Control, Ministry of Health and Welfare, R. O. C. (Taiwan) https://www.cdc.gov.tw/uploads/files/201407/103228a0-fadd-47b0-b056-8dedda9fce1d.pdf. Accessed 23 Feb 2019

Donald PR, van Helden PD (2009) The global burden of tuberculosis--combating drug resistance in difficult times. N Engl J Med 360(23):2393–2395. https://doi.org/10.1056/NEJMp0903806 CrossRefPubMed

De La Rosa GR, Jacobson KL, Rolston KV, Raad II, Kontoyiannis DP, Safdar A (2004) Mycobacterium tuberculosis at a comprehensive cancer centre: active disease in patients with underlying malignancy during 1990-2000. Clin Microbiol Infect 10(8):749–752. https://doi.org/10.1111/j.1469-0691.2004.00954.x CrossRef

10.

Stefan DC, Kruis AL, Schaaf HS, Wessels G (2008) Tuberculosis in oncology patients. Ann Trop Paediatr 28(2):111–116. https://doi.org/10.1179/146532808x302125 CrossRefPubMed

11.

Ibrahim EM, Uwaydah A, al-Mulhim FA, Ibrahim AM, el-Hassan AY (1989) Tuberculosis in patients with malignant disease. Indian J Cancer 26(2):53–57PubMed

12.

Liu CJ, Hong YC, Teng CJ, Hung MH, Hu YW, Ku FC, Chen YT, Chien SH, Yeh CM, Chen TJ, Chiou TJ, Gau JP, Tzeng CH (2015) Risk and impact of tuberculosis in patients with chronic myeloid leukemia: a nationwide population-based study in Taiwan. Int J Cancer 136(8):1881–1887. https://doi.org/10.1002/ijc.29201 CrossRefPubMed

13.

Salvado M, Garcia-Vidal C, Vazquez P, Riera M, Rodriguez-Carballeira M, Martinez-Lacasa J, Cuchi E, Garau J (2010) Mortality of tuberculosis in very old people. J Am Geriatr Soc 58(1):18–22. https://doi.org/10.1111/j.1532-5415.2009.02619.x CrossRefPubMed

14.

Tocque K, Bellis MA, Beeching NJ, Syed Q, Remmington T, Davies PD (2001) A case-control study of lifestyle risk factors associated with tuberculosis in Liverpool, North-West England. Eur Respir J 18(6):959–964. https://doi.org/10.1183/09031936.01.00211701 CrossRefPubMed

15.

Singh PN, Natto Z, Yel D, Job J, Knutsen S (2012) Betel quid use in relation to infectious disease outcomes in Cambodia. Int J Infect Dis 16(4):e262–e267. https://doi.org/10.1016/j.ijid.2011.12.006 CrossRefPubMedPubMedCentral

16.

Lin CC, Chiang JH, Li CI, Liu CS, Lin WY, Hsieh TF, Li TC (2014) Cancer risks among patients with type 2 diabetes: a 10-year follow-up study of a nationwide population-based cohort in Taiwan. BMC Cancer 14:381. https://doi.org/10.1186/1471-2407-14-381 CrossRefPubMedPubMedCentral

17.

Baker MA, Lin HH, Chang HY, Murray MB (2012) The risk of tuberculosis disease among persons with diabetes mellitus: a prospective cohort study. Clin Infect Dis 54(6):818–825. https://doi.org/10.1093/cid/cir939 CrossRefPubMed

18.

Zumla A, Raviglione M, Hafner R, von Reyn CF (2013) Tuberculosis. N Engl J Med 368(8):745–755. https://doi.org/10.1056/NEJMra1200894 CrossRefPubMed

19.

Volkmann T, Moonan PK, Miramontes R, Oeltmann JE (2015) Tuberculosis and excess alcohol use in the United States, 1997-2012. Int J Tuberc Lung Dis 19(1):111–119. https://doi.org/10.5588/ijtld.14.0516 CrossRefPubMedPubMedCentral

20.

Nair R, Prabhash K, Sengar M, Bakshi A, Gujral S, Gupta S, Parikh P (2007) The effect of short-term intensive chemotherapy on reactivation of tuberculosis. Ann Oncol 18(7):1243–1245. https://doi.org/10.1093/annonc/mdm107 CrossRefPubMed

21.

Huang SF, Li CP, Feng JY, Chao Y, Su WJ (2011) Increased risk of tuberculosis after gastrectomy and chemotherapy in gastric cancer: a 7-year cohort study. Gastric Cancer 14(3):257–265. https://doi.org/10.1007/s10120-011-0037-1 CrossRefPubMed

22.

Kaplan MH, Armstrong D, Rosen P (1974) Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer 33(3):850–858CrossRef

23.

Cooper JS, Fu K, Marks J, Silverman S (1995) Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys 31(5):1141–1164. https://doi.org/10.1016/0360-3016(94)00421-g CrossRefPubMed

24.

Han G, Zhang H, Xie CH, Zhou YF (2011) Th2-like immune response in radiation-induced lung fibrosis. Oncol Rep 26(2):383–388. https://doi.org/10.3892/or.2011.1300 CrossRefPubMed

25.

Park B, Yee C, Lee KM (2014) The effect of radiation on the immune response to cancers. Int J Mol Sci 15(1):927–943. https://doi.org/10.3390/ijms15010927 CrossRefPubMedPubMedCentral

26.

Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung G, Law WS, Tam CM, Chan CK, Chang KC (2007) Lower risk of tuberculosis in obesity. Arch Intern Med 167(12):1297–1304. https://doi.org/10.1001/archinte.167.12.1297 CrossRefPubMed

27.

Rondinone CM (2006) Adipocyte-derived hormones, cytokines and mediators. Endocrine 29(1):81–90. https://doi.org/10.1385/endo:29:1:181 CrossRefPubMed

28.

Yen YF, Yen MY, Lin YP, Shih HC, Li LH, Chou P, Deng CY (2013) Directly observed therapy reduces tuberculosis-specific mortality: a population-based follow-up study in Taipei, Taiwan. PLoS One 8(11):e79644. https://doi.org/10.1371/journal.pone.0079644 CrossRefPubMedPubMedCentral

Title: Increased risk of tuberculosis in oral cancer patients in an endemic area: a nationwide population-based study
Authors: Chung-Jen Teng
Leh-Kiong Huon
Yu-Mei Zheng
Chiu-Mei Yeh
Chun-Kuang Tsai
Jin-Hwang Liu
Tzeng-Ji Chen
Chia-Jen Liu
Ya-Ling Lee
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Tuberculosis
Oral Cancer
Tuberculosis
Human Immunodeficiency Virus
Radiotherapy
Diabetes
Oral Cavity Carcinoma
Cytostatic Therapy
Published in: Clinical Oral Investigations / Issue 12/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-019-02864-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Increased risk of tuberculosis in oral cancer patients in an endemic area: a nationwide population-based study

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 12/2019

Histological evaluation of hard tissue formation after direct pulp capping with a fast-setting mineral trioxide aggregate (RetroMTA) in humans

Perioperative management of oral anticoagulated patients undergoing an oral, implant, or periodontal procedure: a survey of practices of members of two dental scientific societies, the PRADICO study

Patient-reported outcomes measures (PROMs) following a piezocision-assisted versus conventional orthodontic treatments: a randomized controlled trial in adults

Wavelength-dependent light transmittance in resin composites: practical implications for curing units with different emission spectra

Clinical performance of tooth- or implant-supported veneered zirconia single crowns: 42-month results

Prediabetes and diabetes prevalence in the Workers’ Oral Health Study