Invasive pulmonary aspergillosis in patients with lung cancer: risk factors for in-hospital mortality and predictors of clinical outcomes - 29/06/25

Doi : 10.1016/j.mycmed.2025.101560

Linling Zhang ^a , Tingting Wu ^a , Hongyuan Jia ^b,^⁎
^a Department of Respiratory and Critical Care, Chengdu Third People's Hospital, Chengdu, China
^b Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China

^⁎Corresponding author at: Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China.Department of Radiation OncologySichuan Clinical Research Center for CancerSichuan Cancer Hospital & InstituteUniversity of Electronic Science and Technology of ChinaChengduChina.

Highlights

•	This is the largest series of lung cancer patients with IPA reported so far.
•	Risk factors for in-hospital mortality in lung cancer patients with IPA included hypoalbuminia, febrile neutropenia, and respiratory failure.
•	Respiratory failure was associated with a lower adds of successful response to antifungal treatment.
•	Treatment containing voriconazole/isavuconazole was associated with a higher adds of successful response to antifungal treatment.

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Abstract

Background

Invasive pulmonary aspergillosis (IPA) is a common complication in patients with hematological malignancies, and has also been reported in some solid tumors, but IPA in lung cancer patients has not been well described in recent years. This study aims to identify the risk factors for in-hospital mortality, and factors influencing antifungal efficacy in lung cancer patients with IPA.

Methods

We retrospectively collected data from all inpatients with positive aspergillus cultures or positive polymerase chain reaction(PCR) for aspergillus DeoxyriboNucleic Acid (DNA) in respiratory samples in the Third People's Hospital of Chengdu from January 2016 to December 2023. A total of 101 lung cancer patients with IPA were identified. Patients were divided into survival (n = 77) and non-survival (n = 24) groups. We analyzed their clinical characteristics, laboratory examination, risk factors for in-hospital mortality, and responses to antifungal treatment.

Results

Among 101 lung cancer patients diagnosed with IPA, The most common isolated species was Aspergillus section fumigati (61.39 %). Aspergillus culture were positive in 65 cases (64.36 %), and positive PCR were 41 cases (40.59 %). 86 patients (85.15 %) received treatment containing voriconazole or isavuconazole. The in-hospital mortality rate was 23.76 % (n = 24). Independent risk factors for in-hospital mortality included low albumin level (odds ratio [OR] 0.80, 95 % confidence interval[CI], -0.279–1.881, P = 0.0025), respiratory failure (OR 12.7, 95 % CI, 10.2–15.2,P = 0.0055), and febrile neutropenia (FN) (OR 7.33,95 % CI,5.21–9.45,P = 0.0079). In multivariate analysis of antifungal treatment response, respiratory failure was associated with lower odds of a successful response (OR 13.3, 95 %CI, 9.64–16.92, P = 0.0447), whereas treatment containing voriconazole or isavuconazole was associated with higher odds (OR 7.51, 95 % CI, 5.22–9.79, P = 0.0147).

Conclusion

Risk factors for in-hospital mortality in lung cancer patients with IPA included hypoalbuminia, FN, and respiratory failure. In antifungal treatment response, respiratory failure was associated with a lower adds of successful response, whereas treatment containing voriconazole or isavuconazole was associated with a higher odds.

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Keywords : Lung cancer, Invasive pulmonary aspergillosis, Mortality, Risk factors, Efficacy