Oncoclínicas Group, São Paulo, Brazil.
JCO Glob Oncol. 2021 Jan;7:46-55. doi: 10.1200/GO.20.00444.
The COVID-19 pandemic remains a public health emergency of global concern. Determinants of mortality in the general population are now clear, but specific data on patients with cancer remain limited, particularly in Latin America.
A longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas community oncology practice in Brazil was conducted. The primary end point was all-cause mortality after isolation of the SARS-CoV-2 by Real-Time Polymerase Chain Reaction (RT-PCR) in patients initially diagnosed in an outpatient environment. We performed univariate and multivariable logistic regression analysis and recursive partitioning modeling to define the baseline clinical determinants of death in the overall population.
From March 29 to July 4, 2020, 198 patients with COVID-19 were prospectively registered in the database, of which 167 (84%) had solid tumors and 31 (16%) had hematologic malignancies. Most patients were on active systemic therapy or radiotherapy (77%), largely for advanced or metastatic disease (64%). The overall mortality rate was 16.7% (95% CI, 11.9 to 22.7). In univariate models, factors associated with death after COVID-19 diagnosis were age ≥ 60 years, current or former smoking, coexisting comorbidities, respiratory tract cancer, and management in a noncurative setting ( < .05). In multivariable logistic regression and recursive partitioning modeling, only age, smoking history, and noncurative disease setting remained significant determinants of mortality, ranging from 1% in cancer survivors under surveillance or (neo)adjuvant therapy to 60% in elderly smokers with advanced or metastatic disease.
Mortality after COVID-19 in patients with cancer is influenced by prognostic factors that also affect outcomes of the general population. Fragile patients and smokers are entitled to active preventive measures to reduce the risk of SARS-CoV-2 infection and close monitoring in the case of exposure or COVID-19-related symptoms.
COVID-19 大流行仍然是全球关注的公共卫生紧急事件。目前已经明确了普通人群死亡率的决定因素，但癌症患者的具体数据仍然有限，特别是在拉丁美洲。
对巴西 Oncoclínicas 社区肿瘤学实践中患有癌症且经实时聚合酶链反应（RT-PCR）确诊 COVID-19 的患者进行了一项纵向多中心队列研究。主要终点是在最初在门诊环境中诊断的患者中通过 RT-PCR 分离 SARS-CoV-2 后所有原因的死亡率。我们进行了单变量和多变量逻辑回归分析和递归分区建模，以确定总体人群死亡的基线临床决定因素。
2020 年 3 月 29 日至 7 月 4 日，前瞻性地在数据库中登记了 198 例 COVID-19 患者，其中 167 例（84%）患有实体瘤，31 例（16%）患有血液系统恶性肿瘤。大多数患者正在接受积极的全身治疗或放射治疗（77%），主要用于晚期或转移性疾病（64%）。总体死亡率为 16.7%（95%CI，11.9%至 22.7%）。在单变量模型中，与 COVID-19 诊断后死亡相关的因素包括年龄≥60 岁、当前或既往吸烟、并存合并症、呼吸道癌和非治愈性治疗（<0.05）。在多变量逻辑回归和递归分区模型中，仅年龄、吸烟史和非治愈性疾病状况仍然是死亡率的重要决定因素，范围从处于监测或（新）辅助治疗的癌症幸存者的 1%到患有晚期或转移性疾病的老年吸烟者的 60%。
癌症患者 COVID-19 后的死亡率受影响预后的因素影响，这些因素也影响普通人群的结局。脆弱的患者和吸烟者有权采取积极的预防措施，以降低感染 SARS-CoV-2 的风险，并在接触或出现 COVID-19 相关症状时进行密切监测。
