Table 1_Incidence and predictors of pulmonary aspergillosis in patients with lung cancer: a systematic review and meta-analysis.docx

BackgroundPulmonary aspergillosis is a rare but serious complication following lung cancer surgery, increasing the risk of mortality. The incidence of pulmonary aspergillosis and its risk factors among lung cancer patients is unknown. This study systematically investigates the incidence and associated risk factors of pulmonary aspergillosis in lung cancer patients.
MethodsThe databases PubMed, Web of Science, Scopus, Embase, CINAHL, and the Cochrane Library were comprehensively searched from their inception to March 2025. The overall incidence of pulmonary aspergillosis among lung cancer patients was analyzed using a random-effects model with logit transformation. Risk factors for pulmonary aspergillosis in lung cancer patients were presented as odds ratios (ORs) with 95% confidence intervals (CIs), calculated using a random-effects model.
ResultsNine retrospective studies involving 20,138 patients with lung cancer were selected for the final analysis. The overall incidence of pulmonary aspergillosis in lung cancer patients was 2.4% (95% confidence interval [CI]: 1.5–3.2%). Subgroup analyses revealed higher incidences of pulmonary aspergillosis than corresponding subgroups in the following categories: Asia (2.8%; 95% CI: 2.0–3.7%), diagnosis by serological test (11.7%; 95% CI: 8.0–15.4%), patients with both non-small cell lung cancer and small cell lung cancers (3.6%; 95% CI: 2.0–5.2%), patients treated with chemoradiotherapy (5.7%; 95% CI: 1.6–9.7%), and pooled studies with moderate quality (2.9%; 95% CI: 1.7–3.2%). Moreover, the risk factors for pulmonary aspergillosis in lung cancer patients included male sex (OR: 1.96; p = 0.008), current or past smoking (odds ratio [OR]: 2.92; p < 0.001), chronic obstructive pulmonary disease (OR: 1.88; p = 0.011), interstitial lung disease (OR: 3.71; p < 0.001), pulmonary tuberculosis (OR: 2.79; p = 0.028), and treatment with double lobectomy (OR: 2.74; p < 0.001).
ConclusionOur study highlights pulmonary aspergillosis as a significant complication in lung cancer patients, with an overall incidence of 2.4%. The identified risk factors provide crucial insights for targeted screening and intervention in this patient population. Future research should focus on validating these findings in prospective studies and exploring the underlying biological mechanisms to develop more effective preventive and treatment strategies.
Systematic review registrationThis study was registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) platform (number: INPLASY2024100066).

【背景】肺曲霉病（Pulmonary aspergillosis）是肺癌术后罕见但严重的并发症，会增加患者的死亡风险。目前肺癌患者中肺曲霉病的发病率及其危险因素尚不明确。本研究系统探讨了肺癌患者肺曲霉病的发病率及相关危险因素。
【方法】本研究全面检索了PubMed、Web of Science、Scopus、Embase、CINAHL及Cochrane Library数据库自建库至2025年3月的相关文献。采用随机效应模型（random-effects model）结合logit变换（logit transformation）分析肺癌患者肺曲霉病的总体发病率。以比值比（odds ratios, OR）及95%置信区间（95% confidence intervals, CI）呈现肺癌患者肺曲霉病的危险因素，所有分析均采用随机效应模型计算。
【结果】最终纳入9项回顾性研究（retrospective studies），共涉及20,138例肺癌患者。肺癌患者肺曲霉病的总体发病率为2.4%（95%CI：1.5%~3.2%）。亚组分析（subgroup analyses）显示，以下亚组的肺曲霉病发病率更高：亚洲人群（2.8%；95%CI：2.0%~3.7%）、经血清学检测（serological test）确诊的患者（11.7%；95%CI：8.0%~15.4%）、同时合并非小细胞肺癌（non-small cell lung cancer）与小细胞肺癌（small cell lung cancer）的患者（3.6%；95%CI：2.0%~5.2%）、接受放化疗（chemoradiotherapy）的患者（5.7%；95%CI：1.6%~9.7%）以及中等质量的合并研究（2.9%；95%CI：1.7%~3.2%）。此外，肺癌患者发生肺曲霉病的危险因素包括男性（OR=1.96；P=0.008）、当前或既往吸烟（OR=2.92；P<0.001）、慢性阻塞性肺疾病（chronic obstructive pulmonary disease）（OR=1.88；P=0.011）、间质性肺疾病（interstitial lung disease）（OR=3.71；P<0.001）、肺结核（pulmonary tuberculosis）（OR=2.79；P=0.028）以及接受双肺叶切除术（double lobectomy）治疗（OR=2.74；P<0.001）。
【结论】本研究证实肺曲霉病是肺癌患者的重要并发症，总体发病率为2.4%。本研究明确的危险因素可为该人群的靶向筛查与干预提供关键依据。未来的研究应在前瞻性研究（prospective studies）中验证本研究结果，并探索其潜在的生物学机制，以开发更有效的预防与治疗策略。
【系统评价注册】本研究已在国际系统评价与Meta分析方案注册平台（International Platform of Registered Systematic Review and Meta-analysis Protocols, INPLASY）注册（注册号：INPLASY2024100066）。