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Peer-reviewedCC BY 4.0PLOS One

Extended treatment duration and recurrence in successfully treated drug-susceptible pulmonary tuberculosis with cavity on chest radiograph

  • Chang-Seok Yoon1
  • Tae-Ok Kim2
  • Hong-Joon Shin3
  • Ju Sang Kim4
  • Hyung Woo Kim5
  • Eung Gu Lee6
  • Sung Soo Jung7
  • Jee Youn Oh8
  • Jin Woo Kim9
  • Heayon Lee10
  • Seunghoon Kim11
  • Sun-Hyung Kim12
10 more authors
  • Yeonhee Park13
  • Jiwon Lyu14
  • Sun Jung Kwon15
  • Yun-Jeong Jeong16
  • Do Jin Kim17
  • Hyeon-Kyoung Koo18
  • Ganghee Chae
  • Sun Young Kyung
  • Jinsoo Min
  • Yong-Soo Kwon
18 affiliations
  1. 1Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
  2. 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
  3. 3Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
  4. 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
  5. 5Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
  6. 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
  7. 7Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  8. 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
  9. 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
  10. 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
  11. 11Department of Pulmonary and Critical Care Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
  12. 12Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
  13. 13Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
  14. 14Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
  15. 15Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
  16. 16Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea
  17. 17Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
  18. 18Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Abstract

Background: Cavity on chest radiograph is recognized as an independent risk factor for recurrence in pulmonary tuberculosis (TB), but evidence supporting extended treatment in these patients remains limited, particularly in real-world data from Korea. Methods: We performed a retrospective analysis using data from a multicenter prospective cohort of patients with pulmonary tuberculosis enrolled at 18 Korean institutions, comparing recurrence rates between standard treatment (≤200 days) and extended treatment (>200 days) among drug-susceptible pulmonary TB patients with cavity on chest radiograph. Results: Among 159 patients, 58 (36.5%) received standard treatment and 101 (63.5%) received extended treatment. Baseline sputum smear positivity was higher in the extended group (29.3% vs. 56.4%, p = 0.002), but 2-month culture positivity (6.3% vs. 4.4%, p > 0.999) and time to culture conversion (8.00 ± 3.91 vs. 7.45 ± 3.73 weeks, p = 0.454) were similar. Recurrence during post-treatment follow-up occurred in 4 patients (2.5%) and did not differ between groups (3.4% vs. 2.0%, p = 0.966). Treatment interruption due to adverse drug reactions was more frequent with extended treatment (1.7% vs. 7.9%, p = 0.204), while overall adverse event rates were comparable. In a fixed-time analysis using Firth’s penalized logistic regression, extended treatment showed a numerically lower risk of recurrence, although statistical significance was not reached (adjusted odds ratio [aOR], 0.07; 95% confidence interval [CI], 0.01–1.06; p = 0.056). Among covariates, low body mass index was associated with recurrence, but this estimate was very imprecise and should be interpreted with caution. Conclusion: Cavity on chest radiograph alone may not be sufficient to justify routine extension of treatment beyond 200 days. Because only four recurrence events were observed, the adjusted association favoring extended treatment was imprecise and should be interpreted as exploratory rather than definitive. Larger prospective studies that systematically capture microbiologic response and detailed radiologic disease burden are needed to identify which patients with cavitary disease may benefit from individualized treatment extension.

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Cite

BibTeXRIS
BibTeX
@article{yoon2026extended,
  title = {{Extended treatment duration and recurrence in successfully treated drug-susceptible pulmonary tuberculosis with cavity on chest radiograph}},
  author = {Chang-Seok Yoon and Tae-Ok Kim and Hong-Joon Shin and Ju Sang Kim and Hyung Woo Kim and Eung Gu Lee and Sung Soo Jung and Jee Youn Oh and Jin Woo Kim and Heayon Lee and Seunghoon Kim and Sun-Hyung Kim and Yeonhee Park and Jiwon Lyu and Sun Jung Kwon and Yun-Jeong Jeong and Do Jin Kim and Hyeon-Kyoung Koo and Ganghee Chae and Sun Young Kyung and Jinsoo Min and Yong-Soo Kwon},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357772},
  url = {https://doi.org/10.1371/journal.pone.0357772},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Extended treatment duration and recurrence in successfully treated drug-susceptible pulmonary tuberculosis with cavity on chest radiograph
AU  - Chang-Seok Yoon
AU  - Tae-Ok Kim
AU  - Hong-Joon Shin
AU  - Ju Sang Kim
AU  - Hyung Woo Kim
AU  - Eung Gu Lee
AU  - Sung Soo Jung
AU  - Jee Youn Oh
AU  - Jin Woo Kim
AU  - Heayon Lee
AU  - Seunghoon Kim
AU  - Sun-Hyung Kim
AU  - Yeonhee Park
AU  - Jiwon Lyu
AU  - Sun Jung Kwon
AU  - Yun-Jeong Jeong
AU  - Do Jin Kim
AU  - Hyeon-Kyoung Koo
AU  - Ganghee Chae
AU  - Sun Young Kyung
AU  - Jinsoo Min
AU  - Yong-Soo Kwon
PY  - 2026
DA  - 2026/09/10
JO  - PLOS One
DO  - 10.1371/journal.pone.0357772
UR  - https://doi.org/10.1371/journal.pone.0357772
AB  - Background: Cavity on chest radiograph is recognized as an independent risk factor for recurrence in pulmonary tuberculosis (TB), but evidence supporting extended treatment in these patients remains limited, particularly in real-world data from Korea. Methods: We performed a retrospective analysis using data from a multicenter prospective cohort of patients with pulmonary tuberculosis enrolled at 18 Korean institutions, comparing recurrence rates between standard treatment (≤200 days) and extended treatment (>200 days) among drug-susceptible pulmonary TB patients with cavity on chest radiograph. Results: Among 159 patients, 58 (36.5%) received standard treatment and 101 (63.5%) received extended treatment. Baseline sputum smear positivity was higher in the extended group (29.3% vs. 56.4%, p = 0.002), but 2-month culture positivity (6.3% vs. 4.4%, p > 0.999) and time to culture conversion (8.00 ± 3.91 vs. 7.45 ± 3.73 weeks, p = 0.454) were similar. Recurrence during post-treatment follow-up occurred in 4 patients (2.5%) and did not differ between groups (3.4% vs. 2.0%, p = 0.966). Treatment interruption due to adverse drug reactions was more frequent with extended treatment (1.7% vs. 7.9%, p = 0.204), while overall adverse event rates were comparable. In a fixed-time analysis using Firth’s penalized logistic regression, extended treatment showed a numerically lower risk of recurrence, although statistical significance was not reached (adjusted odds ratio [aOR], 0.07; 95% confidence interval [CI], 0.01–1.06; p = 0.056). Among covariates, low body mass index was associated with recurrence, but this estimate was very imprecise and should be interpreted with caution. Conclusion: Cavity on chest radiograph alone may not be sufficient to justify routine extension of treatment beyond 200 days. Because only four recurrence events were observed, the adjusted association favoring extended treatment was imprecise and should be interpreted as exploratory rather than definitive. Larger prospective studies that systematically capture microbiologic response and detailed radiologic disease burden are needed to identify which patients with cavitary disease may benefit from individualized treatment extension.
SN  - 1932-6203
ER  -