Russell Beth, Moss Charlotte, Papa Sophie, Irshad Sheeba, Ross Paul, Spicer James, Kordasti Shahram, Crawley Danielle, Wylie Harriet, Cahill Fidelma, Haire Anna, Zaki Kamarul, Rahman Fareen, Sita-Lumsden Ailsa, Josephs Debra, Enting Deborah, Lei Mary, Ghosh Sharmistha, Harrison Claire, Swampillai Angela, Sawyer Elinor, D'Souza Andrea, Gomberg Simon, Fields Paul, Wrench David, Raj Kavita, Gleeson Mary, Bailey Kate, Dillon Richard, Streetly Matthew, Rigg Anne, Sullivan Richard, Dolly Saoirse, Van Hemelrijck Mieke
Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.
Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom.
Front Oncol. 2020 Jul 22;10:1279. doi: 10.3389/fonc.2020.01279. eCollection 2020.
There is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies. We used data from a single large UK Cancer Center to assess the demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February and 12 May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death. 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with a severe case of the disease. An initial cancer diagnosis >24 months before COVID-19 [OR: 1.74 (95% CI: 0.71-4.26)], presenting with fever [6.21 (1.76-21.99)], dyspnea [2.60 (1.00-6.76)], gastro-intestinal symptoms [7.38 (2.71-20.16)], or higher levels of C-reactive protein [9.43 (0.73-121.12)] were linked with greater COVID-19 severity. During a median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Being of Asian ethnicity [3.73 (1.28-10.91)], receiving palliative treatment [5.74 (1.15-28.79)], having an initial cancer diagnosis >24 months before [2.14 (1.04-4.44)], dyspnea [4.94 (1.99-12.25)], and increased CRP levels [10.35 (1.05-52.21)] were positively associated with COVID-19 death. An inverse association was observed with increased levels of albumin [0.04 (0.01-0.04)]. A longer-established diagnosis of cancer was associated with increased severity of infection as well as COVID-19 death, possibly reflecting the effects a more advanced malignant disease has on this infection. Asian ethnicity and palliative treatment were also associated with COVID-19 death in cancer patients.
由于缺乏大型研究，目前尚无足够证据支持为确诊感染新冠病毒的癌症患者提供临床决策依据。我们利用英国一家大型癌症中心的数据，评估了2020年2月29日至5月12日期间156例确诊感染新冠病毒的癌症患者的人口统计学/临床特征。采用逻辑回归/考克斯比例风险模型来确定哪些人口统计学和/或临床特征与新冠病毒感染的严重程度/死亡相关。128例（82%）表现为轻度/中度新冠病毒感染，28例（18%）为重症。新冠病毒感染前24个月以上初次确诊癌症[比值比：1.74（95%置信区间：0.71 - 4.26）]、出现发热[6.21（1.76 - 21.99）]、呼吸困难[2.60（1.00 - 6.76）]、胃肠道症状[7.38（2.71 - 20.16）]或C反应蛋白水平升高[9.43（0.73 - 1,21.12）]与更严重的新冠病毒感染相关。在中位随访37天期间，34例患者死于新冠病毒感染（22%）。亚裔种族[3.73（1.28 - 10.91）]、接受姑息治疗[5.74（1.15 - 28.79）]、新冠病毒感染前24个月以上初次确诊癌症[2.14（1.04 - 4.44）]、呼吸困难[4.94（1.99 - 12.25）]以及C反应蛋白水平升高[10.35（1.05 - 52.21）]与新冠病毒感染死亡呈正相关。白蛋白水平升高呈负相关[0.04（0.01 - 0.04）]。确诊癌症时间较长与感染严重程度以及新冠病毒感染死亡增加相关，这可能反映了更晚期恶性疾病对这种感染的影响。亚裔种族和姑息治疗也与癌症患者的新冠病毒感染死亡相关。
