Journal Article

Epidemiology and risk factors of invasive pulmonary fungal disease in patients with lung cancer

Hou, Ruigang, Jiang, Kaiyao, Hao, Zhiying, Song, Yan, Wang, Lijuan, Qu, Meiyu

2025

Overview

Patients with lung cancer exhibit heightened susceptibility to invasive pulmonary fungal diseases (IPFD) due to malignancy-associated immunosuppression. Current data on the pathogen distribution profile of IPFD in this population remain limited. This study investigated the epidemiological distribution of fungal pathogens causing IPFD in patients with lung cancer, with the aim of guiding clinical management. We conducted a retrospective analysis of consecutive patients with lung cancer treated at the Second Hospital of Shanxi Medical University from June 2019 to May 2024. Patients were included if they had a discharge diagnosis of IPFD, received antifungal therapy, or presented microbiological evidence of fungal infection. All patients were diagnosed according to the 2007 Revised Consensus on Pulmonary Fungal Infections. Demographic, clinical, and laboratory data were collected. Univariate and multivariate logistic regression analyses were employed to identify independent IPFD risk factors. Of 1274 with lung cancer, 92 had proven or probable IPFD. Candida spp. (57.4 %) and Aspergillus spp. (35.3 %) were the predominant pathogens, with sputum (77.94 %), bronchoalveolar lavage fluid (17.65 %), and tissue (4.41 %) as specimen sources. Multivariate analysis identified the following independent risk factors for IPFD with lung cancer: hypertension (OR=5.08; 95 %CI: 1.41–18.28, P = 0.013), chronic respiratory diseases (OR=3.13; 95 %CI: 1.14–8.56, P = 0.026), bone marrow suppression (OR=2.72; 95 % CI: 1.17–6.33, P = 0.020), multiple comorbidities (OR=2.68; 95 % CI: 1.02–7.09, P = 0.046), and smoking (OR=2.47; 95 %CI: 1.08–5.64, P = 0.032). Candida and Aspergillus species were the most common causative agents of IPFD in patients with lung cancer. However, the emergence of less common fungi such as Geotrichum capitatum and Rhizopus microsporus, observed with increasing frequency in this study, warrants heightented clinical vigilance. Recognizing key risk factors, including chronic respiratory diseases, male sex, hypertension, multiple comorbidities and smoking, may guide early diagnosis and targeted antifungal therapy, ultimately improving clinical outcomes. •This study revealed the etiological epidemiological characterisrics of IPFD in lung cancer patients in northern China.•Aspergillus species were predominantly isolated from lung tissue and BALF samples, highlighting the need for empirical antifungal therapy targeting Aspergillus in high-risk lung cancer patients.•We also identified rarely fungi including Neurospora and Rhizopus microsporus, which have not been emphasized in previous studies.•Bone marrow suppression, comorbidities and smoking history were identified as key predisposing factors for IPFD in lung cancer patients.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adult / Aged / Aged, 80 and over / Antifungal Agents - therapeutic use / Antigens / Aspergillus / Aspergillus - isolation & purification / Bronchus / Cancer therapies / Candida / Chemotherapy / Chronic obstructive pulmonary disease / Comorbidity / Diabetes / Diagnosis / Electronic health records / Epidemiology / Female / Fungal diseases / Fungal infections / Hospitals / Humans / Hypertension / Immunosuppression / Invasive Fungal Infections - epidemiology / Invasive Pulmonary Fungal Disease / Invasiveness / Laboratories / Lavage / Lung cancer / Lung diseases / Lung Diseases, Fungal - epidemiology / Lung Diseases, Fungal - microbiology / Lung Neoplasms - complications / Lung Neoplasms - epidemiology / Lung Neoplasms - immunology / Male / Malignancy / Middle Aged / Missing data / Mortality / Multivariate analysis / Myelosuppression / Pathogens / pathongenic fungi / Patients / Population studies / Regression analysis / Respiratory diseases / Retrospective Studies / Risk Factors / Smoking / Sputum / Vigilance