Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.
Faculty of Medicine, University of Oxford, Medical Sciences Divisional Office, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Clin Oncol (R Coll Radiol). 2021 Mar;33(3):e180-e191. doi: 10.1016/j.clon.2020.11.006. Epub 2020 Nov 19.
Much of routine cancer care has been disrupted due to the perceived susceptibility to SARS-CoV-2 infection in cancer patients. Here, we systematically review the current evidence base pertaining to the prevalence, presentation and outcome of COVID-19 in cancer patients, in order to inform policy and practice going forwards. A keyword-structured systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 in cancer patients. Studies were critically appraised using the NIH National Heart, Lung and Blood Institute's quality assessment tool set. The pooled prevalence of cancer as a co-morbidity in patients with COVID-19 and pooled in-hospital mortality risk of COVID-19 in cancer patients were derived by random-effects meta-analyses. In total, 110 studies from 10 countries were included. The pooled prevalence of cancer as a co-morbidity in hospitalised patients with COVID-19 was 2.6% (95% confidence interval 1.8%, 3.5%, I: 92.0%). Specifically, 1.7% (95% confidence interval 1.3%, 2.3%, I: 57.6.%) in China and 5.6% (95% confidence interval 4.5%, 6.7%, I: 82.3%) in Western countries. Patients most commonly presented with non-specific symptoms of fever, dyspnoea and chest tightness in addition to decreased arterial oxygen saturation, ground glass opacities on computer tomography and non-specific changes in inflammatory markers. The pooled in-hospital mortality risk among patients with COVID-19 and cancer was 14.1% (95% confidence interval 9.1%, 19.8%, I: 52.3%). We identified impeding questions that need to be answered to provide the foundation for an iterative review of the developing evidence base, and inform policy and practice going forwards. Analyses of the available data corroborate an unfavourable outcome of hospitalised patients with COVID-19 and cancer. Our findings encourage future studies to report detailed social, demographic and clinical characteristics of cancer patients, including performance status, primary cancer type and stage, as well as a history of anti-cancer therapeutic interventions.
由于癌症患者对 SARS-CoV-2 感染的易感性，常规癌症治疗的大部分已经中断。在这里，我们系统地回顾了当前关于癌症患者 COVID-19 的患病率、表现和结局的证据基础，以便为今后的政策和实践提供信息。我们在 Pubmed、Cochrane、Embase 和 MedRxiv 数据库中使用关键词结构的系统搜索，检索报告癌症患者 COVID-19 主要数据的研究。使用 NIH 国家心脏、肺和血液研究所的质量评估工具集对研究进行了批判性评估。通过随机效应荟萃分析得出癌症作为 COVID-19 住院患者合并症的合并患病率和癌症患者 COVID-19 住院死亡率的合并风险。共纳入来自 10 个国家的 110 项研究。COVID-19 住院患者合并癌症的合并患病率为 2.6%（95%置信区间 1.8%，3.5%，I：92.0%）。具体而言，中国为 1.7%（95%置信区间 1.3%，2.3%，I：57.6%），西方国家为 5.6%（95%置信区间 4.5%，6.7%，I：82.3%）。患者最常见的表现为发热、呼吸困难和胸闷等非特异性症状，此外还伴有动脉血氧饱和度降低、计算机断层扫描磨玻璃影和非特异性炎症标志物变化。COVID-19 和癌症患者的住院死亡率合并风险为 14.1%（95%置信区间 9.1%，19.8%，I：52.3%）。我们确定了需要回答的阻碍问题，为迭代审查不断发展的证据基础提供了基础，并为今后的政策和实践提供了信息。对现有数据的分析证实了 COVID-19 合并癌症住院患者的不良结局。我们的研究结果鼓励未来的研究报告癌症患者的详细社会、人口和临床特征，包括表现状态、原发性癌症类型和阶段以及抗癌治疗干预的历史。
