Incidence and Risk Assessment of Pulmonary Aspergillosis in Lung Cancer Survivors: A Nationwide Longitudinal Study

Lung cancer survivors may be at increased risk of pulmonary aspergillosis due to structural lung damage and treatment-related immunosuppression, yet population-based data quantifying this risk are limited. Using the Korean National Health Insurance Service database, we conducted a nationwide retrospective cohort study of 37,005 surgically treated lung cancer survivors (2010-2017) and 111,015 age- and sex-matched controls without lung cancer. Incident pulmonary aspergillosis was identified using ICD-10 codes, and its association with lung cancer survivorship was evaluated using multivariable Cox proportional hazards models adjusted for demographic factors and comorbidities, with additional analyses in a health-screening subgroup. Among 148,020 participants followed for 1,126,079 person-years, lung cancer survivors had a significantly higher incidence of pulmonary aspergillosis than age- and sex-matched controls (1.96 vs 0.39 per 1,000 person-years), with an increased adjusted risk (adjusted HR, 4.47; 95% CI, 3.83-5.21). The risk increased in a stepwise manner with treatment intensity and was highest among patients who received combined surgery, chemotherapy, and radiotherapy (adjusted HR, 15.00; 95% CI, 11.91-18.88). This elevated risk was greatest within the first year after diagnosis and remained significant at 5 years. Lung cancer survivors had a significantly increased risk of pulmonary aspergillosis compared with matched controls, particularly during the early post-treatment period and among those receiving multimodal therapy.