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Original Research: Chest Infections |

Risk Factors for TB in Patients With Early Gastric CancerGastrectomy as a Risk Factor for TB: Is Gastrectomy a Significant Risk Factor for TB? FREE TO VIEW

Il Ju Choi, MD, PhD; Young-Woo Kim, MD, PhD; Hee Seok Lee, MD; Keun Won Ryu, MD, PhD; Hong Man Yoon, MD; Bang Wool Eom, MD; Chan Gyoo Kim, MD, PhD; Jong Yeul Lee, MD; Soo-Jeong Cho, MD, PhD; Byung-Ho Nam, PhD
Author and Funding Information

From the Center for Gastric Cancer (Drs Choi, Y.-W. Kim, Ryu, Yoon, Eom, C. G. Kim, J. Y. Lee, and Cho), the Respiratory Clinic and Division of Respiratory and Critical Care Medicine (Dr H. S. Lee), Department of Internal Medicine, and the Cancer Biostatistics Branch (Dr Nam), Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea.

CORRESPONDENCE TO: Hee Seok Lee, MD, Respiratory Clinic and Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, 410-769, South Korea; e-mail: jekyde7@gmail.com


Drs Choi and Y.-W. Kim are co-first authors.

FUNDING/SUPPORT: This work was supported by the National Cancer Center [Grant 1210551].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):774-783. doi:10.1378/chest.15-0056
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BACKGROUND:  Gastrectomy is known as one of the risk factors for TB. However, there is no study about the association between TB development and gastrectomy performed in patients with early gastric cancer (EGC). This study evaluated conventional risk factors, including gastrectomy, associated with TB development in patients with EGC.

METHODS:  A retrospective cohort study was performed using the database of the Center for Gastric Cancer of the National Cancer Center, Korea. The patients with EGC whose T1 lesions were pathologically confirmed by gastrectomy or endoscopic resection were included.

RESULTS:  A total of 1,935 patients constituted the EGC cohort. Of these, 1,495 patients were confirmed by gastrectomy and the remaining 440 by endoscopic resection. The median follow-up duration was 4.9 years, and during this period, 31 cases of TB developed (TB incidence, 334/100,000 person-years; 95% CI, 227-475). Multivariate Cox regression analysis showed that old TB lesion on chest radiograph and gastrectomy were significant risk factors (hazard ratio [HR], 5.01; 95% CI, 2.44-10.28; P < .001; and HR, 8.95; 95% CI, 1.22-65.78; P = .031; respectively). In the gastrectomy subgroup, old TB lesion and ≥ 15% reduction in weight and albumin level about 1 year after gastrectomy were significant risk factors (HR, 4.80; 95% CI, 2.26-10.18; P < .001; HR, 3.08; 95% CI, 1.47-6.48; P = .003; and HR, 5.02; 95% CI, 1.47-17.12; P = .010; respectively).

CONCLUSIONS:  Old TB lesion and gastrectomy were significant risk factors in the EGC cohort. In addition, old TB lesion and ≥ 15% postoperative reductions in weight and albumin level were significant risk factors in the gastrectomy subgroup.

Figures in this Article

TB is one of the most serious public health problems, with > 9 million incident cases and about 2 million deaths globally every year.1 To control TB, it is important not only to treat patients with active pulmonary TB properly without delay after diagnosis but also to keep the high-risk groups of TB development under constant surveillance for rapid diagnosis of pulmonary TB2,3 or to detect and treat their latent TB infection (LTBI) actively before reactivation.4 AIDS, malnutrition, diabetes mellitus (DM), use of immunosuppressive agents, chronic kidney disease requiring hemodialysis, smoking, alcoholism, silicosis, indoor pollution, malignancy, gastrectomy, jejunoileal bypass, old TB lesion on chest radiograph, tumor necrosis factor-α inhibitor, underweight, among others, have been identified as factors related to TB development.58

Since the 1940s, many studies suggested the strong relationship between gastrectomy and TB development.919 However, these studies have several limitations. First, all of these were observational studies without suitable control groups. Second, as most patients of these studies underwent gastrectomy because of perforation, bleeding, or gastric outlet obstruction of peptic ulcer diseases, there were chances that these patients might have had other risk factors for TB development, such as alcoholism, malnutrition, and underweight.20 For these reasons, the contribution of gastrectomy itself to TB development could not be discriminated from that of other risk factors. In addition, although gastrectomy is rarely performed for complications of peptic ulcer diseases now because of the development of medical treatment,2123 it is mainly used as the primary treatment modality for gastric cancer. There are major differences between surgical methods for complications of peptic ulcer diseases and those for gastric cancer (for example, extent of gastric resection, introduction of vagotomy, and lymph node dissection). Thus, postoperative complications, including malnutrition, severe weight loss, and dumping syndrome, will develop in a different manner. Although a study dealt with TB development in patients with gastric cancer,24 there is no study about the association between TB development and gastrectomy performed in patients with early gastric cancer (EGC). In this retrospective cohort study, we aimed to evaluate conventional risk factors, including gastrectomy, associated with TB development in patients with EGC.

Study Design and Population

We performed this retrospective cohort study using the database of the Center for Gastric Cancer of the National Cancer Center (NCC), South Korea. We recruited patients with EGC (pathologically confirmed T1) by gastrectomy or endoscopic resection between June 2001 and December 2008 at the NCC and then excluded the patients who (1) were diagnosed with lymph node metastasis by gastrectomy, (2) were not followed up with chest radiograph over at least 1 year, (3) had active TB at the time of gastrectomy or endoscopic resection or were diagnosed with active TB within 3 months after gastrectomy or endoscopic resection, (4) underwent total gastrectomy after previous subtotal gastrectomy, (5) had distant metastasis after gastrectomy, (6) underwent neoadjuvant chemotherapy before gastrectomy, or (7) underwent both gastrectomy and endoscopic resection serially. Finally, we selected the patients with EGC with T1N0M0 (stage IA). We then searched active TB cases developed until December 2013 in this cohort. The institutional review board of NCC approved this study (NCCNCS-11-492) and did not require written consent from patients.

Variables

The possible risk factors were obtained by retrospective reviews of the medical records. Sociodemographic variables included age, sex, BMI, smoking, and alcohol use. Clinical variables included prior TB treatment, family history of TB, other malignancies except EGC, chemotherapy, DM, chronic kidney disease, silicosis, and old TB lesion on chest radiograph.

Old TB lesion was defined as the apical lesion of either upper lobe, such as bronchovascular distortions, fibrotic bands, small calcified nodules, or bronchiectasis on chest radiograph.25 In the gastrectomy subgroup, changes in weight, cholesterol, hemoglobin, and albumin levels before and 1 year after gastrectomy were collected for subgroup analysis.

Definition and Detection of Active TB in the EGC Cohort

Within 3 months after gastrectomy or endoscopic resection, TB was highly likely to have already developed before gastrectomy or endoscopic resection. Thus, we defined an active TB case as TB diagnosed at least 3 months after gastrectomy or endoscopic resection. We searched for the active TB cases diagnosed or treated at the NCC by (1) outpatient and inpatient diagnosis codes (International Classification of Diseases, Ninth Revision until March 2006 and International Classification of Diseases, Tenth Revision afterward), or (2) prescription for anti-TB medication (isoniazid, rifampicin, ethambutol, pyrazinamide, cycloserine, streptomycin or kanamycin). We searched for active TB cases diagnosed and treated at other hospitals using our database of the Center for Gastric Cancer, which is updated annually by telephone survey at the end of the year.

Diagnostic criteria of TB were classified as follows: (1) microbiologically confirmed TB: positive TB culture or TB polymerase chain reaction (PCR); (2) TB pleurisy: lymphocyte-dominant exudate and adenosine deaminase > 70 IU/L on pleural fluid analysis; (3) pathologically diagnosed TB: chronic granulomatous inflammation and the negative results of both TB and nontuberculous mycobacteria PCR from pathologic specimens; (4) radiologic TB: typical radiologic features of active TB; and (5) unknown cases. In cases classified as criteria 3, 4, and 5, radiologic and clinical improvements after anti-TB treatment were found.

Statistical Analysis

TB incidence was calculated as the number of new active TB cases per person-year (PY) of follow-up for each risk factor. Cox proportional hazards regression models were performed to identify risk factors associated with time for the development of active TB using Stata statistical software version 12.1 (StataCorp LP). Variables that showed an association at P < .2 in univariable analysis, as well as age and sex, were considered as candidates for the multivariable model. A forward stepwise approach was used to determine the final model, and variables with P < .1 were retained in this model.

Clinical Characteristics of the EGC Cohort

A total of 2,588 patients were diagnosed with EGC by gastrectomy and endoscopic resection between June 2001 and December 2008 at the NCC. After a total of 653 patients were excluded according to the exclusion criteria, 1,935 patients constituted the EGC cohort. Of these, 1,495 patients (77.3%) had T1N0M0 (stage IA) tumor pathologically confirmed by gastrectomy, and the remaining 440 (22.7%) had T1 tumor pathologically confirmed by endoscopic resection and N0M0 clinical stage assessed by abdominal CT scan (Fig 1).

Figure Jump LinkFigure 1 –  The flowchart of the EGC cohort selection. *Endoscopic resection included endoscopic mucosal resection or endoscopic submucosal dissection. #Gastrectomy included total or partial gastrectomy via open or laparoscopic method. As reconstruction methods, Roux-en-Y was used for total gastrectomy, Billroth I or Billroth II for partial gastrectomy. EGC = early gastric cancer.Grahic Jump Location

The median age of 1,935 patients at the time of entry was 59 years (range, 24-88 years), and 1,288 (66.6%) were men. Only 38 patients (2%) had low BMI (< 18.5 kg/m2), and 201 (10.4%) had DM. One hundred thirty patients (6.7%) had received anti-TB treatment previously, and 59 (3%) had family history of TB. In addition to EGC, 178 patients (9.2%) had other malignancies, and about one-third of them had received chemotherapy. Of all patients with EGC, 258 (13.3%) had an old TB lesion on chest radiograph checked before gastrectomy or endoscopic resection. Other risk factors and TB incidence are described in Table 1.

Table Graphic Jump Location
TABLE 1 ]  Baseline Risk Factors and TB Incidence of the EGC Cohort (N = 1,935)

EGC = early gastric cancer; PY = person-year.

a 

Because of missing information, a total of 1,919 cases with alcohol history were analyzed.

TB Development After the Treatment of EGC

The median follow-up time was 4.9 years (range, 1-11.3 years) in the EGC cohort; there were 9,272 PY follow-up. More than 90% of patients were followed for > 3 years, and 18 patients (0.9%) died during follow-up.

During this follow-up period, a total of 31 cases of TB developed, and the TB incidence was 334 per 100,000 PY (95% CI, 227-475) (Table 1). The median time from the treatment of EGC (gastrectomy or endoscopic resection) to TB development was 38 months (range, 4-126 months). In detail, 30 cases of TB developed within 5 years after gastrectomy or endoscopic resection, and only one case developed 10½ years after gastrectomy.

Of these 31 TB cases, 25 were pulmonary TB, three pulmonary TB along with pleurisy, one only TB pleurisy, and two TB colitis. Twenty-eight pulmonary TB cases consisted of 20 microbiologically confirmed TB, three radiologic TB, two pathologically diagnosed TB, and three unknown cases. Two TB enteritis cases were diagnosed with positive result of TB PCR.

Of 29 cases with pulmonary TB or pleurisy, 23 cases were diagnosed at the NCC and the remaining six cases at other hospitals between regular check-ups. Of 23 cases diagnosed at the NCC, nine were discovered at regular check-ups in the outpatient department (OPD) of the Center for Gastric Cancer, six were discovered at regular check-ups in the OPD other than the Center for Gastric Cancer, six were during visits to the OPD or ED for respiratory or other symptoms, and two were during visits to the OPD because of chest radiograph abnormality checked at other hospitals. Two cases with TB colitis were diagnosed at the NCC. Both patients underwent colonoscopy: one for colonic wall thickening on abdominal CT scan at the regular check-up and the other for abdominal pain.

Risk Factors Associated With TB Development in the EGC Cohort

Both old TB lesion and gastrectomy were significantly associated with TB development on a univariate analysis by the Cox proportional hazards regression models. TB incidence in patients with EGC with old TB lesion was 1,057 per 100,000 PY (95% CI, 563-1,807), whereas the incidence without old TB lesion was 224 per 100,000 PY (95% CI, 133-354). Hazard ratio (HR) in patients with EGC with old TB lesion was 4.63 (95% CI, 2.26-9.49; P < .001). Likewise, TB incidence in patients with EGC treated with gastrectomy was 418 per 100,000 PY (95% CI, 282-597), whereas the incidence treated with endoscopic resection was 48 per 100,000 PY (95% CI, 1-266). HR in patients with EGC treated with gastrectomy was 7.92 (95% CI, 1.08-58.16; P = .042). For reference, TB incidence of this age group in the general population was 87 per 100,000 PY in 2013; age-specific TB incidence is compared in Figure 2.26

Figure Jump LinkFigure 2 –  Comparison of TB incidence between the EGC cohort and the general population in 2013. See Figure 1 legend for expansion of abbreviation. (Data from Korea Centers for Disease Control and Prevention.26)Grahic Jump Location

In the final model using a multivariate analysis, both old TB lesion and gastrectomy were retained as significant predictors of time for TB development in the EGC cohort. The adjusted HR for old TB lesion was significantly higher (HR, 5.01; 95% CI, 2.44-10.28; P < .001), and it was also higher for gastrectomy (HR, 8.95; 95% CI, 1.22-65.78; P = .031) (Table 2).

Table Graphic Jump Location
TABLE 2 ]  Hazard Ratios for TB Development in the EGC Cohort

HR = hazard ratio. See Table 1 legend for expansion of other abbreviation.

a 

HR adjusted by age, sex, and other variables with P < .2 in univariate analysis, that is, BMI, previous TB history, other malignancies, old TB lesion on chest radiograph, and gastrectomy.

b 

Because of missing information, a total of 1,919 cases with alcohol history were analyzed.

Risk Factors for TB Development in the Gastrectomy Subgroup

In the gastrectomy subgroup (n = 1,495), there were 7,174 PY of follow-up, and 30 cases of TB developed, so the TB incidence was 418 per 100,000 PY (95% CI, 282-597) (Table 3). On a univariate analysis, old TB lesion (HR, 4.67; 95% CI, 2.24-9.75; P < .001), > 15% reductions in weight and albumin level about 1 year after gastrectomy (HR, 2.86; 95% CI, 1.38-5.94; P = .005; and HR, 6.91; 95% CI, 1.98-24.10; P = .002; respectively), and partial gastrectomy with Billroth II reconstruction (vs Billroth I reconstruction: HR, 2.54; 95% CI, 1.12-5.76; P = .026) were significant risk factors. However, the final model using a multivariate analysis showed that only old TB lesion and > 15% reductions in weight and albumin level after gastrectomy were significant risk factors (HR, 4.80; 95% CI, 2.26-10.18; P < .001; HR, 3.08; 95% CI, 1.47-6.48; P = .003; and HR 5.02; 95% CI, 1.47-17.12; P = .010; respectively) (Table 4).

Table Graphic Jump Location
TABLE 3 ]  Baseline Risk Factors and TB Incidence of the Gastrectomy Subgroup (n = 1,495)

PG = partial gastrectomy; TG = total gastrectomy. See Table 1 legend for expansion of other abbreviation.

a 

Because of missing information, a total of 1,489 cases with alcohol history were analyzed.

b 

Weight reduction about 1 y after gastrectomy.

Table Graphic Jump Location
TABLE 4 ]  Risk Factor for TB Development in the Gastrectomy Subgroup

See Table 2 and 3 legends for expansion of abbreviations.

a 

HR adjusted by age, sex, and other variables with a P value < .2 in univariate analysis, that is, BMI, previous TB history, other malignancies, surgical method, old TB lesion on chest radiograph, and > 15% reduction of weight and albumin level after gastrectomy.

b 

Because of missing information, a total of 1,489 cases with alcohol history were analyzed.

c 

Weight reduction about 1 y after gastrectomy.

This is the first cohort study, to our knowledge, to analyze risk factors for TB development in patients with EGC. Among many risk factors for TB development, old TB lesion and gastrectomy were significant risk factors in 1,935 patients with EGC (HR of old TB lesion vs no old TB lesion, 5.01; 95% CI, 2.44-10.28; P < .001; and HR of gastrectomy vs endoscopic resection, 8.95; 95% CI, 1.22-65.78; P = .031). Actually, compared with TB incidence of this age group in the general population (87 of 100,000 in 2013), TB incidence of EGC cohort, gastrectomy subgroup, and subgroup with old TB lesion (334 of 100,000, 418 of 100,000, and 1,057 of 100,000, respectively) were about four, five, and 12 times higher, respectively. Also, this study found that old TB lesion and > 15% reductions in weight and albumin level about 1 year after gastrectomy were significant risk factors in 1,495 patients who had gastrectomy (HR, 4.80; 95% CI, 2.26-10.18; P < .001; HR, 3.08; 95% CI, 1.47-6.48; P = .003; and HR, 5.02; 95% CI, 1.47-17.12; P = .010; respectively).

The mechanism of TB development in patients who had gastrectomy is not well known. However, the hypothesis is that many patients who had gastrectomy are more likely to undergo malnutrition,27 the loss of nutrients essential for immune system function will induce immune deficiency,28,29 and, finally, new active TB can develop. As evidence of the relationship between malnutrition after gastrectomy and TB development, one Swedish study showed that dumping syndrome related to postgastrectomy malnutrition was more common among 38 patients with TB who had gastrectomy than among 317 patients without TB who had gastrectomy (74% vs 34%).30 In addition, it demonstrated that TB relapses after gastrectomy were related to weight loss and malabsorption of iron, vitamin D, and anemia. Likewise, in this gastrectomy subgroup, > 15% reductions from preoperative weight and albumin level about 1 year after gastrectomy were significant risk factors for TB development. These results indirectly suggest that fat malabsorption31 and malnutrition are associated with TB development. On the other hand, there is some evidence for immunologic alteration related to gastrectomy. In one Japanese study on 79 patients with gastric cancer treated with gastrectomy, 80% of the patients had weight loss of > 5% of preoperative weight, more than one-fourth of patients had low levels of prealbumin and albumin, and > 30% of patients had low CD3+ lymphocyte subpopulation and low CD4/CD8 ratio of lymphocytes.32 However, it is still not known exactly which immune mechanisms are involved in TB development in patients who had gastrectomy, so more research is needed to solve this complex issues.

Huang et al24 presented the results of a 7-year gastric cancer cohort study. Since this Taiwan study included patients with gastric cancer of all stages from Ia to IV, it showed patients who underwent therapeutic gastrectomy, palliative surgery, chemotherapy, supportive care, and a combination of them according to their own stages and medical conditions, and TB development in the gastrectomy group was compared with that of palliative surgery or no-treatment group (adjusted risk ratio of gastrectomy, 3.76; 95% CI, 1.43-9.9; multivariate logistic regression, P = .007). However, it is possible to suppose that the palliative surgery or no-treatment group had low incidence of TB because they had not lived long enough for active TB to have developed, whereas the gastrectomy group had high incidence of TB because they had lived long enough. Indeed, the average follow-up duration of the gastrectomy group was about 4 years, but that of the palliative group was only about 1 year, and this difference in the follow-up period might affect the incidence of TB in this Taiwan study. In addition, as 14.5% of patients in this Taiwan study had no chest radiograph checked before treatment, these patients had no information on whether they had old TB lesion or active pulmonary TB before treatment. This problem can also affect the statistical results.

Although gastrectomy is considered as a risk factor for TB development over 70 years, there is no study issued on the potential benefit and cost-effectiveness of TB screening, the most effective screening tools and screening intervals, the total duration of follow-up, and the need for systematic testing and treatment of LTBI in patients who had gastrectomy. Until these issues are confirmed by well-designed studies, constant surveillance with chest imaging and treatment of LTBI in patients who had gastrectomy could be considered positively on the basis of our study results.

This study has several merits. First, this cohort study targeted patients with EGC. Because most of the patients with EGC were long-term survivors, the median follow-up duration in our cohort was 4.9 years, and given the fact that most of the TB cases developed during the first 5 years after the treatment of EGC, the follow-up duration for observing new TB development in this cohort was quite appropriate. In addition, since there were no residual tumors or no need for adjuvant chemotherapy after the treatment of EGC, the confounding effects by remnant tumors or the chemotherapy had been blocked in advance. Second, the endoscopic resection group was used as an appropriate comparison group for the assessment of risk of TB development in the gastrectomy group. Third, we used our annually updated database of the Center for Gastric Cancer that enabled more accurate assessment for TB development, the interval to TB development, the follow-up duration, and so forth.

At the same time, this study has some limitations. First, as a result of the retrospective cohort study of a single institution, it would have had some biases and confounders. To minimize these problems, we made efforts as stated previously. Second, it is possible that active pulmonary TB of some patients could not be detected on chest radiograph only because of its low sensitivity. Small TB lesions may sometimes be missed, active TB lesions can be misinterpreted as old TB from the beginning, and TB reactivation can be missed when it is masked by old TB lesions. In reality, of 29 cases with pulmonary TB or pleurisy in this study, two cases with small active TB lesions were diagnosed accidentally only by low-dose chest CT scan for lung cancer screening, not by chest radiograph of routine check-ups. However, this verification bias cannot be avoided, because chest CT scan is not used routinely for the detection of small TB lesions.

In conclusion, old TB lesion and gastrectomy were significant risk factors in the EGC cohort. In addition, old TB lesion and > 15% reductions in weight and albumin level after surgery were significant risk factors in the gastrectomy subgroup. According to the results of this study, particular attention should be paid to TB development in patients with EGC with old TB lesion and in patients who had gastrectomy, especially with considerable postoperative reductions in weight and albumin level.

Author contributions: H. S. L. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. H. S. L. contributed to study design, data analysis and interpretation, and manuscript writing; Y.-W. K., K. W. R., H. M. Y., and B. W. E. contributed to provision of data of patients with EGC treated with gastrectomy; I. J. C., C. G. K., J. Y. L., and S.-J. C. contributed to provision of data of patients with EGC treated with endoscopic resection; B.-H. N. contributed to statistical analysis; I. J. C. and Y.-W. K. contributed to data analysis and manuscript writing; and I. J. C., Y.-W. K., H. S. L., K. W. R., H. M. Y., B. W. E., C. G. K., J. Y. L., S.-J. C., and B.-H. N. contributed to manuscript revision and final approval.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or in the preparation of the manuscript.

DM

diabetes mellitus

EGC

early gastric cancer

HR

hazard ratio

LTBI

latent TB infection

NCC

National Cancer Center

OPD

outpatient department

PCR

polymerase chain reaction

PY

person-year

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Figures

Figure Jump LinkFigure 1 –  The flowchart of the EGC cohort selection. *Endoscopic resection included endoscopic mucosal resection or endoscopic submucosal dissection. #Gastrectomy included total or partial gastrectomy via open or laparoscopic method. As reconstruction methods, Roux-en-Y was used for total gastrectomy, Billroth I or Billroth II for partial gastrectomy. EGC = early gastric cancer.Grahic Jump Location
Figure Jump LinkFigure 2 –  Comparison of TB incidence between the EGC cohort and the general population in 2013. See Figure 1 legend for expansion of abbreviation. (Data from Korea Centers for Disease Control and Prevention.26)Grahic Jump Location

Tables

Table Graphic Jump Location
TABLE 1 ]  Baseline Risk Factors and TB Incidence of the EGC Cohort (N = 1,935)

EGC = early gastric cancer; PY = person-year.

a 

Because of missing information, a total of 1,919 cases with alcohol history were analyzed.

Table Graphic Jump Location
TABLE 2 ]  Hazard Ratios for TB Development in the EGC Cohort

HR = hazard ratio. See Table 1 legend for expansion of other abbreviation.

a 

HR adjusted by age, sex, and other variables with P < .2 in univariate analysis, that is, BMI, previous TB history, other malignancies, old TB lesion on chest radiograph, and gastrectomy.

b 

Because of missing information, a total of 1,919 cases with alcohol history were analyzed.

Table Graphic Jump Location
TABLE 3 ]  Baseline Risk Factors and TB Incidence of the Gastrectomy Subgroup (n = 1,495)

PG = partial gastrectomy; TG = total gastrectomy. See Table 1 legend for expansion of other abbreviation.

a 

Because of missing information, a total of 1,489 cases with alcohol history were analyzed.

b 

Weight reduction about 1 y after gastrectomy.

Table Graphic Jump Location
TABLE 4 ]  Risk Factor for TB Development in the Gastrectomy Subgroup

See Table 2 and 3 legends for expansion of abbreviations.

a 

HR adjusted by age, sex, and other variables with a P value < .2 in univariate analysis, that is, BMI, previous TB history, other malignancies, surgical method, old TB lesion on chest radiograph, and > 15% reduction of weight and albumin level after gastrectomy.

b 

Because of missing information, a total of 1,489 cases with alcohol history were analyzed.

c 

Weight reduction about 1 y after gastrectomy.

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