Incidence and predictors of pulmonary aspergillosis in patients with lung cancer: A systematic review and meta-analysis

Geling Teng ^1* Feng Jin ¹ Hua Zhang ¹ Min Zhang ²

• ¹ Shandong Public Health Clinical Center, Jinan, China
• ² Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China

Background: Pulmonary aspergillosis is a rare but significant complication following lung cancer surgery, which increases the risk of mortality. The incidence of pulmonary aspergillosis and risk factors among lung cancer patients is unknown. This study systematically investigates the incidence of pulmonary aspergillosis and associated risk factors in lung cancer patients.The databases of PubMed, Web of Science, Scopus, Embase, CINAHL, and the Cochrane Library were comprehensively searched from their inception up to March 2025. The overall incidences of pulmonary aspergillosis among lung cancer patients were analyzed using a random-effects model with logit transformation.Meanwhile, the risk factors for pulmonary aspergillosis in lung cancer patients were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), calculated by a random-effects model.Nine retrospective studies involving 20,138 patients with lung cancer were selected for final analysis. The incidence of pulmonary aspergillosis in lung cancer patients was 2.4% (95%CI: 1.5%-3.2%). Subgroup analyses found the incidence of pulmonary aspergillosis in Asia (2.8%; 95%CI: 2.0%-3.7%), the diagnostic criteria for pulmonary aspergillosis was serological test (11.7%; 95%CI: 8.0%-15.4%), patients contained non-small cell lung cancer and small cell lung cancer (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%) were higher than corresponding subgroups. Moreover, the risk factors for pulmonary aspergillosis in lung cancer patients included male sex (OR: 1.96; P=0.008), current or past smoking (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 patients treated with double lobectomy (OR: 2.74; P<0.001).Our study highlights that pulmonary aspergillosis is a notable complication in lung cancer patients, with an overall incidence of 2.4%. The identified risk factors offer 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 approaches.Systematic review registration: INPLASY2024100066.