EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal.
Int J Cancer. 2021 Jul 15;149(2):287-296. doi: 10.1002/ijc.33532. Epub 2021 Mar 13.
The COVID-19 pandemic led to potential delays in diagnosis and treatment of cancer patients, which may negatively affect the prognosis of these patients. Our study aimed to quantify the impact of COVID-19 on the short-term survival of cancer patients by comparing a period of 4 months after the outbreak began (2 March 2020) with an equal period from 2019. All cancer cases of the esophagus, stomach, colon and rectum, pancreas, lung, skin-melanoma, breast, cervix, and prostate, from the Portuguese Oncology Institute of Porto (IPO-Porto) and diagnosed between 2 March and 1 July of 2019 (before COVID-19) and 2020 (after COVID-19) were identified. Information regarding sociodemographic, clinical and treatment characteristics were collected from the cancer registry database and clinical files. Vital status was assessed to 31 October of the respective years. Cox proportional hazards regression was used to estimate crude and propensity score-adjusted hazards ratio (HR) and 95% confidence intervals (95% CIs) of death. During follow-up to 31 October, there were 154 (11.8%) deaths observed before COVID-19 and 131 (17.2%) after COVID-19, corresponding to crude and adjusted HRs (95% CI) of 1.51 (1.20-1.91) and 1.10 (0.86-1.40), respectively. Significantly higher adjusted hazards of death were observed for patients with Stage III cancer (HR = 2.37; 95% CI: 1.14-4.94) and those undergoing surgical treatment (HR = 3.97; 95% CI: 1.14-13.77) or receiving radiotherapy (HR = 1.96; 95% CI: 1.96-3.74), while patients who did not receive any treatment had a lower mortality hazards (HR = 0.62; 95% CI: 0.46-0.83). The higher overall short-term mortality observed during the COVID-19 pandemic largely reflects the effects of the epidemic on the case-mix of patients being diagnosed with cancer.
新型冠状病毒肺炎（COVID-19）大流行导致癌症患者的诊断和治疗可能出现延误，这可能对这些患者的预后产生负面影响。我们的研究旨在通过比较疫情爆发开始后 4 个月（2020 年 3 月 2 日）与 2019 年同期的情况，来量化 COVID-19 对癌症患者短期生存率的影响。本研究纳入了葡萄牙波尔图肿瘤研究所（IPO-Porto）的食管、胃、结肠和直肠、胰腺、肺、皮肤黑色素瘤、乳腺、宫颈和前列腺癌病例，这些病例于 2019 年 3 月 2 日至 7 月 1 日（COVID-19 前）和 2020 年（COVID-19 后）期间确诊。从癌症登记数据库和临床档案中收集了有关社会人口学、临床和治疗特征的信息。截止到相应年份的 10 月 31 日，评估了患者的生存状态。使用 Cox 比例风险回归模型估计了 COVID-19 前（154 例，11.8%）和 COVID-19 后（131 例，17.2%）的死亡粗风险比（HR）和倾向评分调整 HR（95%置信区间[95%CI]）。在 10 月 31 日截止的随访期间，COVID-19 前有 154 例（11.8%）死亡，COVID-19 后有 131 例（17.2%），相应的粗 HR（95%CI）为 1.51（1.20-1.91）和调整 HR（95%CI）为 1.10（0.86-1.40）。对于 III 期癌症患者（HR=2.37；95%CI：1.14-4.94）和接受手术治疗（HR=3.97；95%CI：1.14-13.77）或放疗（HR=1.96；95%CI：1.96-3.74）的患者，调整后的死亡风险显著升高，而未接受任何治疗的患者死亡率较低（HR=0.62；95%CI：0.46-0.83）。在 COVID-19 大流行期间观察到的总体短期死亡率较高，在很大程度上反映了疫情对确诊癌症患者病例构成的影响。
