Bronchial Microbiota and the Stress Associated with Invasive Diagnostic Tests in Lung Cancer vs. Benign Pulmonary Diseases: A Cross-Sectional Study

Abstract

Lung cancer is the leading cause of cancer-related deaths worldwide. This study aimed to compare the bronchial microbiota of patients with lung cancer and patients with benign pulmonary diseases undergoing bronchoscopy, and to assess the stress levels associated with invasive diagnostic lung tests. A cross-sectional study was conducted at the “Victor Babes” Hospital for Infectious Diseases and Pulmonology in Timisoara, Romania. A total of 33 patients with histologically diagnosed bronchopulmonary cancer and 33 control patients with benign lung pathologies underwent bronchoscopy. Bronchial microbiota was analyzed by multiplex PCR, culture media, and cytology. Anxiety and depression levels were assessed using the ECOG performance status scale, Karnofsky scale, GAD-7, PHQ-9, and HADS questionnaires. There were no significant differences in the presence of common microbial species between the two groups, except for Acinetobacter spp. Which was identified in 15.2% of patients with lung cancer and 0.0% in the control group, Candida spp. Was more prevalent in the benign group (24.2% vs. 6.1%), and the Parainfluenza virus was detected only in the malignant group (21.1% vs. 0.0%). Cytology results showed a higher prevalence of atypical and tumoral cells in the malignant group (39.4% and 30.0%, respectively), as well as higher lymphocyte levels in the benign group (69.7% vs. 24.2%). Patients with lung cancer had significantly lower performance status on the ECOG scale (2.34 vs. 1.92), lower Karnofsky scores (71.36 vs. 79.43), and higher GAD-7 and PHQ-9 scores at the initial evaluation compared to the benign group. At the 90-day follow-up, ECOG and Karnofsky scores remained significantly different from the initial evaluation, but only GAD-7 scores showed a significant difference between the two groups. There were differences in the bronchial microbiota between patients with lung cancer and benign pulmonary diseases, with a higher prevalence of Candida spp. in the benign group and exclusive detection of Acinetobacter spp. and Parainfluenza virus in the malignant group. Patients with lung cancer exhibited higher stress levels, more severe anxiety, and depression symptoms, which persisted during follow-up. Further research is needed to understand the role of bronchial microbiota in lung cancer and the impact of stress on patient outcomes.