Abstract
BACKGROUND: The concurrent presentation of pulmonary tuberculosis (TB) and lung cancer presents significant diagnostic and therapeutic challenges, with limited evidence guiding clinical management. To address this, we introduced a novel temporal disease-sequence classification. This study aimed to characterize clinical phenotypes and prognostic factors based on this sequence. METHODS: We conducted a retrospective cohort study of 123 patients with confirmed TB and lung cancer at our center (2017-2023). Patients were classified by diagnostic sequence: Simultaneous Coexistence (TB-LC, n=70), Post-TB Lung Cancer (TB→LC, n=35), and Post-LC TB (LC→TB, n=18). Outcomes included demographics, symptom profiles, treatment patterns, and overall survival (OS). Statistical analyses employed Kaplan-Meier methods and Cox regression. RESULTS: Striking intergroup differences were observed. The TB-LC group showed the highest symptom burden (87.14, P=0.007) and chemotherapy utilization (50.00%, P=0.029). OS did not differ significantly (log-rank P=0.276), though median survival varied (TB-LC: 32 months; LC→TB: 57 months; TB→LC: not reached). Multivariable analysis identified surgery (HR=0.34, 95% CI 0.13-0.92) and anti-TB therapy (HR=0.48, 95% CI 0.24-0.97) as protective factors, while advanced stage predicted mortality (HR=6.24, 95% CI 2.27-17.14). CONCLUSION: Temporal disease sequence influences clinical presentation and treatment selection in TB-lung cancer patients. Surgical resection and anti-TB strategies improve outcomes, highlighting the need for integrated management protocols.