Restrictive lung function and smoking increase lung cancer risk in tuberculosis survivors: a cohort study

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; <i>p</i> = 0.050) and obstructive (HR 6.48, 95% CI 2.05–20.43; <i>p</i> < 0.001) lung function, age (HR 2.35 per 5-year; <i>p</i> < 0.001), heavy smoking (HR 6.62; <i>p</i> < 0.001), alcohol (HR 3.05; <i>p</i> = 0.019), and diabetes (HR 6.40; <i>p</i> = 0.003). In multivariable models, restrictive lung function (HR 2.94, 95% CI 1.00–8.65; <i>p</i> = 0.050), age (HR 1.73; <i>p</i> < 0.001), and heavy smoking (HR 4.09; <i>p</i> = 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.