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COVID-19 associated with increased lung cancer risk in current smokers; spike protein drives tumorigenesis in miceStudy finds link between COVID-19 and higher lung cancer risk in current smokers

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Key Takeaway
Consider COVID-19 history as a potential risk factor in lung cancer screening for current smokers, but recognize evidence is observational.

This research combined a retrospective cohort analysis with preclinical mechanistic studies. The human analysis used TriNetX database data from 166,807 current smokers, comparing COVID-19 survivors to propensity score-matched controls without COVID-19. The main finding was that COVID-19 was associated with a significantly increased risk of lung cancer in this population (RR 1.22; HR 1.50, P < 0.001). Preclinical studies in K18-hACE2TG mice exposed to intratracheal SARS-CoV-2 spike protein showed increased lung tumor burden (P < 0.001), while K18-hACE2TG/Tymp–/– mice showed no increase, suggesting a thymidine phosphorylase (TYMP)-dependent mechanism.

Safety and tolerability data were not reported for either the human cohort or animal studies. The research examined secondary outcomes including lung injury, inflammation, thrombosis, fibrosis, STAT3 activation, cytokine profiles, and ACE2 processing in vitro, though specific results for these endpoints were not detailed in the provided data.

Key limitations include the retrospective observational design of the human data, which cannot establish causality, and the use of preclinical mouse models that may not fully translate to human biology. The authors suggest TYMP represents a potential therapeutic target to mitigate long-term pulmonary consequences of COVID-19. Practice relevance is currently limited; these findings should be viewed as generating hypotheses for further investigation rather than guiding clinical decisions.

Researchers investigated whether COVID-19 might be linked to a higher risk of lung cancer, especially for people who smoke. They analyzed health records of over 166,000 current smokers, comparing those who had COVID-19 to a matched group who did not. They found that smokers with a history of COVID-19 had a higher risk of being diagnosed with lung cancer.

To understand why this link might exist, scientists conducted lab studies using genetically modified mice. They found that exposing the mice to the SARS-CoV-2 spike protein, a key part of the virus, could promote lung tumor growth. This effect appeared to depend on a specific protein in the body called thymidine phosphorylase (TYMP).

It is very important to be careful with these results. The human data only shows an association or link; it does not prove that COVID-19 causes lung cancer. Many other factors could explain the connection. The mouse studies are preclinical, meaning they are early lab research and the findings may not translate directly to humans.

Readers should understand this as early scientific exploration. The study suggests a potential long-term health concern worth further investigation, particularly for smokers. The identification of the TYMP protein points scientists toward a possible biological pathway to study in the future, but it is not a current treatment target.

What this means for you:
Early research finds a link between COVID-19 and lung cancer risk in smokers, but more study is needed to understand the connection.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedMar 2026
View Original Abstract ↓
COVID-19 survivors exhibit increased interstitial lung fibrosis, a known risk factor for lung cancer. We investigated whether SARS-CoV-2 spike protein (SP)-induced lung injury and elevated thymidine phosphorylase (TYMP) promote lung tumorigenesis. A TriNetX retrospective cohort analysis was combined with mechanistic studies in K18-hACE2TG and K18-hACE2TG/Tymp–/– mice. Mice received intratracheal SP or control lysate followed by a urethane-induced lung cancer protocol. Lung injury, inflammation, thrombosis, fibrosis, STAT3 activation, cytokine profiles, and tumor burden were assessed. In vitro assays evaluated SP- and RBD-induced ACE2 processing. Propensity score-matched TriNetX cohorts demonstrated an increased lung cancer risk after COVID-19, particularly among current smokers (n = 166,807; RR 1.22; HR 1.50; P SARS-CoV-2 SP drives lung injury, fibrosis, and tumorigenesis through a TYMP-dependent mechanism involving STAT3 signaling and inflammatory microenvironment remodeling. COVID-19 significantly increases lung cancer risk, especially in current smokers. TYMP represents a potential therapeutic target to mitigate long-term pulmonary consequences of COVID-19.
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