Abstract
BACKGROUND: Previous studies report variation in the incidence of pulmonary fungal infection rates and associated factors in lung cancer patients. This meta-analysis aimed to provide a comprehensive synthesis of Chinese- and English-language studies to investigate the incidence of pulmonary fungal infections and their associated factors in these patients. METHODS: Studies reporting the incidence of pulmonary fungal infections or their associated factors in lung cancer patients were systematically searched in the WanFang, CNKI, EMBASE, SinoMed, Web of Science, and PubMed databases until April 2025. RESULTS: In total, 37 studies involving 26 841 lung cancer patients were included. The pooled pulmonary fungal infection rate (95% confidence interval) was 14.00% (12.54%-15.45%) in lung cancer patients. Age ≥ 60 years (odds ratio (OR) = 1.85, p = 0.020), male sex (OR = 1.23, p = 0.019), smoking history (OR = 2.24, p < 0.001), chronic obstructive pulmonary disease (OR = 2.19, p = 0.010), interstitial lung disease (OR = 4.40, p < 0.001), diabetes (OR = 2.31, p < 0.001), anemia (OR = 6.47, p = 0.016), small cell lung cancer (OR = 1.46, p = 0.011), squamous cell carcinoma (OR = 1.38, p = 0.001), tumor stages of III-IV (OR = 2.38, p < 0.001), invasive operation (OR = 3.73, p < 0.001), chemotherapy (OR = 1.64, p = 0.011), chemotherapy cycle > 2 (OR = 2.87, p < 0.001), radiotherapy (OR = 1.67, p = 0.001), chemoradiotherapy (OR = 2.72, p < 0.001), surgery (OR = 1.64, p < 0.001), long-term use of antibiotics (OR = 5.64, p = 0.002), use of glucocorticoid (OR = 4.44, p < 0.001), and hospital stays ≥ 14 days (OR = 3.97, p = 0.006) were linked with higher pulmonary fungal infection risk. CONCLUSION: The pulmonary fungal infection rate (95% CI) was 14.00% (12.54%, 15.45%) in lung cancer patients. Furthermore, the associated factors might help screen for and intervene early in pulmonary fungal infections in patients with lung cancer.