Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK.
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK.
Lancet. 2020 Jun 20;395(10241):1919-1926. doi: 10.1016/S0140-6736(20)31173-9. Epub 2020 May 28.
Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer.
In this prospective observational study, all patients with active cancer and presenting to our network of cancer centres were eligible for enrolment into the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effects of COVID-19 on patients with cancer. Eligible patients tested positive for severe acute respiratory syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded patients with a radiological or clinical diagnosis of COVID-19, without a positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge from hospital, as assessed by the reporting sites during the patient hospital admission.
From March 18, to April 26, 2020, we analysed 800 patients with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a mild COVID-19 disease course. 226 (28%) patients died and risk of death was significantly associated with advancing patient age (odds ratio 9·42 [95% CI 6·56-10·02]; p<0·0001), being male (1·67 [1·19-2·34]; p=0·003), and the presence of other comorbidities such as hypertension (1·95 [1·36-2·80]; p<0·001) and cardiovascular disease (2·32 [1·47-3·64]). 281 (35%) patients had received cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1·18 [0·81-1·72]; p=0·380). We found no significant effect on mortality for patients with immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the past 4 weeks.
Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment.
University of Birmingham, University of Oxford.
患有癌症的个体，特别是正在接受全身抗癌治疗的个体，据推测其因 COVID-19 而死亡的风险增加。这种推测对癌症患者的治疗有重大影响，但由于大流行的特殊情况，缺乏来自大型多中心研究的数据来支持这一假设。我们旨在描述癌症患者的临床和人口统计学特征以及 COVID-19 的结局。
在这项前瞻性观察性研究中，我们网络中的所有患有活动性癌症且出现症状的癌症患者均有资格参加英国冠状病毒癌症监测项目（UKCCMP）。UKCCMP 是第一个 COVID-19 临床登记处，可使一线医生实时了解 COVID-19 对癌症患者的影响。符合条件的患者通过鼻或咽喉拭子的 RT-PCR 检测对严重急性呼吸综合征冠状病毒 2 呈阳性。我们排除了具有 COVID-19 放射学或临床诊断但 RT-PCR 检测呈阴性的患者。主要终点是全因死亡率或报告地点在患者住院期间评估的出院。
从 2020 年 3 月 18 日至 4 月 26 日，我们分析了 800 名患有癌症和有症状 COVID-19 的患者。412 名（52%）患者患有轻度 COVID-19 疾病。226 名（28%）患者死亡，死亡风险与患者年龄的增加显著相关（优势比 9.42[95%CI 6.56-10.02]；p<0.0001）、男性（1.67[1.19-2.34]；p=0.003）和存在其他合并症，如高血压（1.95[1.36-2.80]；p<0.001）和心血管疾病（2.32[1.47-3.64]）。281 名（35%）患者在 COVID-19 检测呈阳性前 4 周内接受了细胞毒性化疗。在调整年龄、性别和合并症后，与未接受近期化疗的癌症患者相比，过去 4 周内接受化疗对 COVID-19 疾病死亡率无显著影响（1.18[0.81-1.72]；p=0.380）。我们未发现细胞免疫疗法、激素疗法、靶向治疗、过去 4 周内放疗对死亡率有显著影响。
癌症患者因 COVID-19 而死亡的情况主要由年龄、性别和合并症驱动。我们无法确定证据表明，与未接受积极治疗的患者相比，接受细胞毒性化疗或其他抗癌治疗的癌症患者因 COVID-19 疾病而死亡的风险增加。
伯明翰大学、牛津大学。
