Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Lombardy, Italy.
Oncologist. 2021 Apr;26(4):341-347. doi: 10.1002/onco.13654. Epub 2021 Jan 7.
In Europe, the SARS-CoV-2 pandemic had its first epicenter in Italy. Despite a significant mortality rate, the severity of most cases of COVID-19 infection ranges from asymptomatic to mildly symptomatic, and silent infection affects a still-unknown proportion of the general population. No information is available on the prevalence and clinical impact of SARS-CoV-2 silent infection among patients with cancer receiving anticancer treatment during the pandemic.
From April 1, 2020, to the end of the same month, 560 consecutive patients with cancer, asymptomatic for COVID-19 and on anticancer treatment at Papa Giovanni XXIII Hospital in Bergamo, were evaluated and tested for SARS-CoV-2. We implemented a two-step diagnostics, including the rapid serological immunoassay for anti-SARS-CoV-2 immunoglobulin (Ig) G/IgM and the nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test in case of seropositivity to identify SARS-CoV-2 silent carriers.
In 560 patients, 172 (31%) resulted positive for anti-SARS-CoV-2 IgM/IgG antibodies, regardless of different type of cancer, stage, and treatment. The Ig-seropositive patients were then tested with RT-PCR nasopharyngeal swabs, and 38% proved to be SARS-CoV-2 silent carriers. At an early follow-up, in the 97 SARS-CoV-2-seropositive/RT-PCR-negative patients who continued their anticancer therapies, only one developed symptomatic COVID-19 illness.
Among patients with cancer, the two-step diagnostics is feasible and effective for SARS-CoV-2 silent carriers detection and might support optimal cancer treatment strategies at both the individual and the population level. The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in cases of RT-PCR-negative patients.
This is the first study evaluating the prevalence and clinical impact of SARS-CoV-2 silent infection in actively treated patients with cancer, during the epidemic peak in one of the worst areas of the COVID-19 pandemic. Lacking national and international recommendations for the detection of asymptomatic SARS-CoV-2 infection, a pragmatic and effective two-step diagnostics was implemented to ascertain SARS-CoV-2 silent carriers. In this series, consisting of consecutive and unselected patients with cancer, the prevalence of both SARS-CoV-2-seropositive patients and silent carriers is substantial (31% and 10%, respectively). The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in case of RT-PCR-negative patients.
在欧洲，SARS-CoV-2 大流行的首个中心位于意大利。尽管死亡率很高，但大多数 COVID-19 感染病例的严重程度从无症状到轻度症状不等，而无声感染影响了一般人群中仍未知比例的人群。目前尚无关于大流行期间接受癌症治疗的癌症患者中 SARS-CoV-2 无声感染的流行率和临床影响的信息。
从 2020 年 4 月 1 日至当月月底，对在贝加莫 Papa Giovanni XXIII 医院接受癌症治疗且无症状的 560 例连续癌症患者进行了评估和 SARS-CoV-2 检测。我们实施了两步诊断，包括针对 SARS-CoV-2 免疫球蛋白（Ig）G/IgM 的快速血清学免疫测定，以及针对血清阳性患者的鼻咽拭子逆转录酶-聚合酶链反应（RT-PCR）检测，以确定 SARS-CoV-2 无声携带者。
在 560 例患者中，有 172 例（31%）抗 SARS-CoV-2 IgM/IgG 抗体呈阳性，无论癌症类型、分期和治疗如何。Ig 血清阳性患者随后接受鼻咽拭子 RT-PCR 检测，其中 38%为 SARS-CoV-2 无声携带者。在早期随访中，在继续接受癌症治疗的 97 例 SARS-CoV-2 血清阳性/RT-PCR 阴性患者中，只有 1 例发展为有症状的 COVID-19 疾病。
在癌症患者中，两步诊断对于 SARS-CoV-2 无声携带者的检测是可行且有效的，可能支持在个体和人群层面制定最佳的癌症治疗策略。在先前接触过 SARS-CoV-2 的患者中，不同抗癌疗法的早期安全性特征支持继续积极治疗的建议，至少在 RT-PCR 阴性患者中如此。
这是第一项评估大流行高峰期在 COVID-19 疫情最严重地区之一的活跃治疗癌症患者中 SARS-CoV-2 无声感染的流行率和临床影响的研究。由于缺乏针对无症状 SARS-CoV-2 感染的国家和国际检测建议，因此实施了一种务实有效的两步诊断，以确定 SARS-CoV-2 无声携带者。在本系列中，由连续和未经选择的癌症患者组成，SARS-CoV-2 血清阳性患者和无声携带者的患病率都很高（分别为 31%和 10%）。在先前接触过 SARS-CoV-2 的患者中，不同抗癌疗法的早期安全性特征支持继续积极治疗的建议，至少在 RT-PCR 阴性患者中如此。
