Oncology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy.
Respiratory Medicine Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy.
Br J Cancer. 2021 Aug;125(3):358-365. doi: 10.1038/s41416-021-01396-9. Epub 2021 May 11.
The impact of active cancer in COVID-19 patients is poorly defined; however, most studies showed a poorer outcome in cancer patients compared to the general population.
We analysed clinical data from 557 consecutive COVID-19 patients. Uni-multivariable analysis was performed to identify prognostic factors of COVID-19 survival; propensity score matching was used to estimate the impact of cancer.
Of 557 consecutive COVID-19 patients, 46 had active cancer (8%). Comorbidities included diabetes (n = 137, 25%), hypertension (n = 284, 51%), coronary artery disease (n = 114, 20%) and dyslipidaemia (n = 122, 22%). Oncologic patients were older (mean age 71 vs 65, p = 0.012), more often smokers (20% vs 8%, p = 0.009), with higher neutrophil-to-lymphocyte ratio (13.3 vs 8.2, p = 0.046). Fatality rate was 50% (CI 95%: 34.9;65.1) in cancer patients and 20.2% (CI 95%: 16.8;23.9) in the non-oncologic population. Multivariable analysis showed active cancer (HR: 2.26, p = 0.001), age (HR: 1.08, p < 0.001), as well as lactate dehydrogenase (HR: 2.42, p = 0.007), PaO2/FiO2 (HR: 1.00, p < 0.001), procalcitonin (HR: 2.21, p < 0.001), coronary artery disease (HR: 1.67, p = 0.010), cigarette smoking (HR: 1.65, p = 0.041) to be independent statistically significant predictors of outcome. Propensity score matching showed a 1.92× risk of death in active cancer patients compared to non-oncologic patients (p = 0.013), adjusted for ICU-related bias. We observed a median OS of 14 days for cancer patients vs 35 days for other patients.
A near-doubled death rate between cancer and non-cancer COVID-19 patients was reported. Active cancer has a negative impact on clinical outcome regardless of pre-existing clinical comorbidities.
COVID-19 患者中活动性癌症的影响尚未明确；然而，大多数研究表明癌症患者的预后较一般人群差。
我们分析了 557 例连续 COVID-19 患者的临床数据。采用单变量和多变量分析确定 COVID-19 生存的预后因素；采用倾向评分匹配估计癌症的影响。
在 557 例连续 COVID-19 患者中，46 例患有活动性癌症（8%）。合并症包括糖尿病（n=137，25%）、高血压（n=284，51%）、冠状动脉疾病（n=114，20%）和血脂异常（n=122，22%）。癌症患者年龄较大（平均年龄 71 岁 vs 65 岁，p=0.012），更常吸烟（20% vs 8%，p=0.009），中性粒细胞与淋巴细胞比值较高（13.3 vs 8.2，p=0.046）。癌症患者的死亡率为 50%（95%CI：34.9；65.1），非肿瘤患者为 20.2%（95%CI：16.8；23.9）。多变量分析显示，活动性癌症（HR：2.26，p=0.001）、年龄（HR：1.08，p<0.001）、乳酸脱氢酶（HR：2.42，p=0.007）、PaO2/FiO2（HR：1.00，p<0.001）、降钙素原（HR：2.21，p<0.001）、冠状动脉疾病（HR：1.67，p=0.010）、吸烟（HR：1.65，p=0.041）是独立的统计学显著预后因素。倾向评分匹配显示，与非肿瘤患者相比，活动性癌症患者的死亡风险增加 1.92 倍（p=0.013），调整了 ICU 相关偏倚。我们观察到癌症患者的中位 OS 为 14 天，而非癌症患者为 35 天。
癌症和非癌症 COVID-19 患者的死亡率几乎翻倍。活动性癌症对临床结局有负面影响，无论是否存在先前的临床合并症。
