Investigating the efficacy and safety of bronchoscopic removal of aspergilloma in PTB-CCPA

Background Given high symptom recurrence rates after discontinuation of antifungal therapy (AF), a comparison was made between AF alone and in combination with bronchoscopic aspergilloma removal (BRA) for treating post-tuberculosis chronic cavitary pulmonary aspergillosis (PTB-CCPA) patients, focusing on fungal ball clearance rate, relapse rate, and relapse risk factors.Methods This retrospective cohort study was conducted at Guangzhou Chest Hospital, China, from January 2014 to December 2021, with follow-up through October 2023. Patients with PTB-CCPA who met diagnostic criteria (cavitary tuberculosis history, CT-confirmed fungal balls, and microbiological/serological Aspergillus evidence) were included.Results The enrolled patients were divided into two groups: the control group (32 patients, 36.4%) received only AF, and the treatment group (56 patients, 63.6%) received a combination of AF and BRA (AF+BRA). The aspergilloma clearance rate in the cavity was 14.8% in the AF group and 100% in the AF+BRA group (p < 0.001). For patients who received AF less than 8 months, Kaplan-Meier survival curve analysis showed that the AF+BRA group had a significantly higher cumulative recurrence-free survival rate (p < 0.05). Notably, AF+BRA shortened the duration of oral AF compared with the AF treatment. Further analysis identified age ≥60 years (HR = 0.12, 95% CI 0.03–0.57, p = 0.007) and the disappearance or reduction in size of the aspergillomas (HR = 0.07, 95% CI 0.01–0.58, p = 0.014) as protective factors against recurrence, while more than one pulmonary cavity increased recurrence risk (HR = 7.4, 95% CI 1.67–32.69, p = 0.008).Conclusions AF+BRA can eliminate Aspergillus fungal balls, may cure PTB-CCPA, shorten antifungal treatment duration, and reduce recurrence and mortality, suggesting that it is a superior treatment approach.