Burden of tuberculosis among patients with cancer: a comprehensive systematic review and meta-analysis of global data.

Background: Patients with cancer are at a higher risk of tuberculosis (TB) infection because of the immunosuppressive effect of prolonged chemotherapy. This study determined the prevalence of TB and TB-related deaths among patients with cancer from a global perspective.

Methodology: We followed the PRISMA guidelines to conduct the current study. Extracted data from relevant articles were analyzed using STATA version 17.0. The effect size estimate was computed using a random-effects model, considering a 95% confidence interval. The I2 statistic and Galbraith plot were used to confirm heterogeneity. A univariate meta-regression, sensitivity, and subgroup analyses were conducted to identify the source of heterogeneity. Egger's test and a funnel plot were used to check publication bias.

Results: Of the thirteen articles comprising 2,135,402 patients with malignancy, 31,073 had TB. The pooled estimate of TB was 3.69% (95% CI: 1.79-5.58%), with high heterogeneity (I2 = 99.99%). The pooled TB prevalence in Europe was 7.04 (95% CI: 1.09-12.99%). The prevalence of TB in a single study in North America was 8.78% (95% CI: 8.45-9.10%). A higher TB prevalence was observed in patients with solid tumors (6.84%; 95% CI: 4.30-9.38%), followed by both hematologic malignancies and solid tumors (3.63%; 95% CI: 1.46-5.80%). Pulmonary and extrapulmonary TB was 3.05% and 0.77%, respectively. The TB-related death was 0.04%. In meta-regression, publication year and sample size didn't affect the heterogeneity.

Conclusion: There is a considerable burden of TB (3.69%) in patients with cancer. This calls for routine TB screening and early treatment of cases to reduce complications.