J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 9, September 2026, pages 612-622

Prediction Model for Detecting Active Pulmonary Tuberculosis in Patients With Head and Neck Cancer Prior to Concurrent Chemoradiotherapy

↓ Figure 5. Relationship between the linear predictor and predicted probability of active PTB. PTB: pulmonary tuberculosis.

↓ **Table 1.** Baseline Characteristics of Patients With and Without Active PTB
Baseline characteristics	Active PTB (n = 30), n (%)	No active PTB (n = 475), n (%)	P-value	AuROC
Albumin was missing in 80 patients. HPV testing was performed mainly in patients with oropharyngeal tumors. Percentages are calculated among those with available HPV results (n = 148). AuROC: area under the receiver operating characteristic curve; BMI: body mass index; HPV: human papillomavirus; IQR: interquartile range; NLR: neutrophil-to-lymphocyte ratio; PTB: pulmonary tuberculosis; SD: standard deviation.
Sex, male, n (%)	9 (30.0)	212 (44.6)	0.131	0.573
Age (years), (mean ± SD)	59.8 ± 11.4	57.3 ± 11.4	0.234	0.544
Comorbidities
Diabetes mellitus	5 (16.7)	30 (6.3)	0.048	0.551
Hypertension	4 (13.3)	78 (16.4)	0.802	0.515
Dyslipidemia	0 (0)	40 (8.4)	0.156	0.500
Smoking history	19 (63.3)	260 (54.7)	0.450	0.543
Alcohol consumption	19 (63.3)	250 (52.6)	0.266	0.553
Tumor site
Larynx	8 (26.7)	63 (13.3)	0.082	0.643
Oropharynx	7 (23.3)	167 (35.2)
Hypopharynx	10 (33.3)	98 (20.6)
Oral cavity	3 (10.0)	83 (17.5)
Nasopharynx	2 (6.7)	64 (13.5)
Histologic grade
Well differentiated	9 (30.0)	205 (43.2)	0.326	0.575
Moderately differentiated	16 (53.3)	192 (40.4)
Poorly differentiated	5 (16.7)	78 (16.4)
Tumor stage (T-stage)
T1	0 (0)	38 (8.0)	0.165	0.580
T2	5 (16.7)	121 (25.5)
T3	9 (30.0)	140 (29.5)
T4	16 (53.3)	176 (37.1)
Nodal stage (N-stage)
N0	5 (16.7)	68 (14.3)	0.054	0.625
N1	3 (10.0)	121 (25.5)
N2	15 (50.0)	239 (50.3)
N3	7 (23.3)	47 (9.9)
Hemoglobin (g/dL), mean ± SD	9.9 ± 1.4	11.9 ± 2.0	< 0.001	0.781
Albumin (g/dL), mean ± SD	3.2 ± 0.5	3.8 ± 0.5	< 0.001	0.812
HPV status (positive)	1/5 (20.0)	16/143 (11.2)	0.462	0.544
NLR, median (IQR)	3.9 (2.1, 7.0)	3.3 (2.1, 5.3)	0.338	0.552
Maximum tumor diameter (cm), mean ± SD	4.9 ± 1.7	4.6 ± 2.1	0.483	0.557
Maximum lymph node diameter (cm), Median (IQR)	2.0 (1.2, 5.0)	1.8 (1.0, 3.0)	0.169	0.563
Unresectable disease	28 (93.3)	419 (88.2)	0.560	0.520
BMI (kg/m²), (mean ± SD)	17.3 ± 3.2	20.3 ± 3.8	< 0.001	0.724
Cancer symptom duration (months), mean ± SD	4.3 ± 2.4	2.3 ± 1.8	< 0.001	0.793

↓ Table 1. Baseline Characteristics of Patients With and Without Active PTB

Baseline characteristics

Active PTB (n = 30), n (%)

No active PTB (n = 475), n (%)

P-value

AuROC

Albumin was missing in 80 patients. HPV testing was performed mainly in patients with oropharyngeal tumors. Percentages are calculated among those with available HPV results (n = 148). AuROC: area under the receiver operating characteristic curve; BMI: body mass index; HPV: human papillomavirus; IQR: interquartile range; NLR: neutrophil-to-lymphocyte ratio; PTB: pulmonary tuberculosis; SD: standard deviation.

Sex, male, n (%)

9 (30.0)

212 (44.6)

0.131

0.573

Age (years), (mean ± SD)

59.8 ± 11.4

57.3 ± 11.4

0.234

0.544

Comorbidities

Diabetes mellitus

5 (16.7)

30 (6.3)

0.048

0.551

Hypertension

4 (13.3)

78 (16.4)

0.802

0.515

Dyslipidemia

0 (0)

40 (8.4)

0.156

0.500

Smoking history

19 (63.3)

260 (54.7)

0.450

0.543

Alcohol consumption

19 (63.3)

250 (52.6)

0.266

0.553

Tumor site

Larynx

8 (26.7)

63 (13.3)

0.082

0.643

Oropharynx

7 (23.3)

167 (35.2)

Hypopharynx

10 (33.3)

98 (20.6)

Oral cavity

3 (10.0)

83 (17.5)

Nasopharynx

2 (6.7)

64 (13.5)

Histologic grade

Well differentiated

9 (30.0)

205 (43.2)

0.326

0.575

Moderately differentiated

16 (53.3)

192 (40.4)

Poorly differentiated

5 (16.7)

78 (16.4)

Tumor stage (T-stage)

0 (0)

38 (8.0)

0.165

0.580

5 (16.7)

121 (25.5)

9 (30.0)

140 (29.5)

16 (53.3)

176 (37.1)

Nodal stage (N-stage)

5 (16.7)

68 (14.3)

0.054

0.625

3 (10.0)

121 (25.5)

15 (50.0)

239 (50.3)

7 (23.3)

47 (9.9)

Hemoglobin (g/dL), mean ± SD

9.9 ± 1.4

11.9 ± 2.0

< 0.001

0.781

Albumin (g/dL), mean ± SD

3.2 ± 0.5

3.8 ± 0.5

< 0.001

0.812

HPV status (positive)

1/5 (20.0)

16/143 (11.2)

0.462

0.544

NLR, median (IQR)

3.9 (2.1, 7.0)

3.3 (2.1, 5.3)

0.338

0.552

Maximum tumor diameter (cm), mean ± SD

4.9 ± 1.7

4.6 ± 2.1

0.483

0.557

Maximum lymph node diameter (cm), Median (IQR)

2.0 (1.2, 5.0)

1.8 (1.0, 3.0)

0.169

0.563

Unresectable disease

28 (93.3)

419 (88.2)

0.560

0.520

BMI (kg/m²), (mean ± SD)

17.3 ± 3.2

20.3 ± 3.8

< 0.001

0.724

Cancer symptom duration (months), mean ± SD

4.3 ± 2.4

2.3 ± 1.8

< 0.001

0.793

↓ **Table 2.** Univariable and Multivariable Logistic Regression Analyses for Active PTB
Predictors	Univariable OR (95% CI)	P-value	Multivariable OR (95% CI)	P-value	AuROC
Multivariable odds ratios were estimated from a single model including body mass index, hemoglobin concentration, serum albumin concentration, and cancer symptom duration; each odds ratio is adjusted for the other three variables in the model. AuROC: area under the receiver operating characteristic curve; BMI: body mass index; CI: confidence interval; OR: odds ratio.
BMI (kg/m²)	0.76 (0.67, 0.87)	< 0.001	0.86 (0.75, 0.99)	0.047	0.882
Hemoglobin (g/dL)	0.60 (0.49, 0.74)	< 0.001	0.75 (0.58, 0.95)	0.021
Albumin (g/dL)	0.14 (0.07, 0.29)	< 0.001	0.25 (0.12, 0.53)	< 0.001
Cancer symptom duration (months)	1.41 (1.23, 1.63)	< 0.001	1.49 (1.25, 1.76)	< 0.001

↓ Table 2. Univariable and Multivariable Logistic Regression Analyses for Active PTB

Predictors

Univariable OR (95% CI)

P-value

Multivariable OR (95% CI)

P-value

AuROC

Multivariable odds ratios were estimated from a single model including body mass index, hemoglobin concentration, serum albumin concentration, and cancer symptom duration; each odds ratio is adjusted for the other three variables in the model. AuROC: area under the receiver operating characteristic curve; BMI: body mass index; CI: confidence interval; OR: odds ratio.

BMI (kg/m²)

0.76 (0.67, 0.87)

< 0.001

0.86 (0.75, 0.99)

0.047

0.882

Hemoglobin (g/dL)

0.60 (0.49, 0.74)

< 0.001

0.75 (0.58, 0.95)

0.021

Albumin (g/dL)

0.14 (0.07, 0.29)

< 0.001

0.25 (0.12, 0.53)

< 0.001

Cancer symptom duration (months)

1.41 (1.23, 1.63)

< 0.001

1.49 (1.25, 1.76)

< 0.001

↓ **Table 3.** Apparent and Internal Validation Performance of the Prediction Model
Parameters	Apparent performance (95% CI)	Bootstrap performance (95% CI)
AuROC: area under the receiver operating characteristic curve; CITL: calibration-in-the-large; E:O ratio: expected-to-observed outcomes ratio.
C-statistic (AuROC)	0.882 (0.814, 0.950)	0.872 (0.805, 0.954)
E:O ratio	1.000	1.034 (0.712, 1.372)
CITL	0.000 (−0.421, 0.421)	−0.024 (−0.512, 0.536)
Calibration slope	1.000 (0.713, 1.287)	0.917 (0.668, 1.287)
Bootstrap shrinkage factor		0.941

↓ Table 3. Apparent and Internal Validation Performance of the Prediction Model

Parameters

Apparent performance (95% CI)

Bootstrap performance (95% CI)

AuROC: area under the receiver operating characteristic curve; CITL: calibration-in-the-large; E:O ratio: expected-to-observed outcomes ratio.

C-statistic (AuROC)

0.882 (0.814, 0.950)

0.872 (0.805, 0.954)

E:O ratio

1.000

1.034 (0.712, 1.372)

CITL

0.000 (−0.421, 0.421)

−0.024 (−0.512, 0.536)

Calibration slope

1.000 (0.713, 1.287)

0.917 (0.668, 1.287)

Bootstrap shrinkage factor

0.941

↓ **Table 4.** Diagnostic Performance of the Prediction Model at the Prevalence-Based Threshold
Model probability of active PTB	Predicted Classification	Active PTB (n = 30), n (% of total)	No active PTB (n = 475), n (% of total)	Diagnostic metrics, % (95% CI)
CI: confidence interval; NPV: negative predictive value; PPV: positive predictive value; PTB: pulmonary tuberculosis.
≥ 5.94%	Positive	27 (5.3)	84 (16.6)	Sensitivity: 90.0% (73.5, 97.9) PPV: 24.3% (16.4, 33.7)
< 5.94%	Negative	3 (0.6)	391 (77.4)	Specificity: 82.3% (78.6, 85.6) NPV: 99.2% (97.8, 99.8)

↓ Table 4. Diagnostic Performance of the Prediction Model at the Prevalence-Based Threshold

Model probability of active PTB

Predicted Classification

Active PTB (n = 30), n (% of total)

No active PTB (n = 475), n (% of total)

Diagnostic metrics, % (95% CI)

CI: confidence interval; NPV: negative predictive value; PPV: positive predictive value; PTB: pulmonary tuberculosis.

≥ 5.94%

Positive

27 (5.3)

84 (16.6)

Sensitivity: 90.0% (73.5, 97.9)
PPV: 24.3% (16.4, 33.7)

< 5.94%

Negative

3 (0.6)

391 (77.4)

Specificity: 82.3% (78.6, 85.6)
NPV: 99.2% (97.8, 99.8)