Department of Medicine, MetroWest Medical Center/Tufts University School of Medicine, Framingham, MA, USA.
Divisão de Pesquisa Clínica e Desenvolvimento Tecnológico, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
Acta Oncol. 2021 Jan;60(1):13-19. doi: 10.1080/0284186X.2020.1837946. Epub 2020 Nov 2.
Cancer patients suffer from worse coronavirus disease-2019 (COVID-19) outcomes. Whether active oncologic treatment is an additional risk factor in this population remains unclear. Therefore, here we have conducted a systematic review and meta-analysis to summarize the existing evidence for the effect of active oncologic treatment on COVID-19 outcomes.
Systematic search of databases (PubMed, Embase) was conducted for studies published from inception to July 1, 2020, with a subsequent search update conducted on 10 October 2020. In addition, abstracts and presentations from major conference proceedings (ASCO, ESMO, AACR) as well as pre-print databases (medxriv, bioxriv) were searched. Retrospective and prospective studies reporting clinical outcomes in cancer patients with laboratory confirmation or clinical diagnosis of COVID-19 and details of active or recent oncologic treatment were selected. Random-effects model was applied throughout meta-analyses. Summary outcome measure was the pooled odds ratio (OR) of death for active cancer therapy versus no active cancer therapy for each of the following modalities: recent surgery, chemotherapy, targeted therapy, immunotherapy, or chemoimmunotherapy.
Sixteen retrospective and prospective studies (3558 patients) were included in the meta-analysis. Active chemotherapy was associated with higher risk of death compared to no active chemotherapy (OR, 1.60, 95% CI, 1.14-2.23). No significant association with risk of death was identified for active targeted therapy, immunotherapy, chemoimmunotherapy, or recent surgery. Meta-analysis of multivariate adjusted OR of death for active chemotherapy was consistently associated with higher risk of death compared to no active chemotherapy (OR, 1.42, 95% CI, 1.01-2.01).
Active chemotherapy appears to be associated with higher risk of death in cancer patients with COVID-19. Further research is necessary to characterize the complex interactions between active cancer treatment and COVID-19.
癌症患者的冠状病毒病 2019（COVID-19）结局更差。在该人群中，是否进行积极的肿瘤治疗是另一个危险因素尚不清楚。因此，我们在这里进行了系统评价和荟萃分析，以总结现有关于积极肿瘤治疗对 COVID-19 结局影响的证据。
从开始到 2020 年 7 月 1 日，对数据库（PubMed、Embase）进行系统搜索，随后于 2020 年 10 月 10 日进行了搜索更新。此外，还对主要会议论文集（ASCO、ESMO、AACR）和预印本数据库（medxriv、bioxriv）的摘要和演讲进行了搜索。选择了报告癌症患者临床结局的回顾性和前瞻性研究，这些患者经实验室确认或临床诊断患有 COVID-19，并详细记录了积极或近期的肿瘤治疗情况。荟萃分析中应用了随机效应模型。主要结局指标为以下各治疗方式中积极癌症治疗与无积极癌症治疗的死亡合并比值比（OR）：近期手术、化疗、靶向治疗、免疫治疗或化疗免疫治疗。
荟萃分析纳入了 16 项回顾性和前瞻性研究（3558 例患者）。与无积极化疗相比，积极化疗与死亡风险增加相关（OR，1.60，95% CI，1.14-2.23）。积极靶向治疗、免疫治疗、化疗免疫治疗或近期手术与死亡风险无显著相关性。荟萃分析多元校正后，积极化疗与无积极化疗相比，死亡风险仍更高（OR，1.42，95% CI，1.01-2.01）。
积极化疗似乎与 COVID-19 癌症患者的死亡风险增加有关。需要进一步研究以阐明积极的肿瘤治疗与 COVID-19 之间的复杂相互作用。
