Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan.
Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
JAMA Oncol. 2021 Aug 1;7(8):1141-1148. doi: 10.1001/jamaoncol.2021.2159.
Patients with cancer and health care workers (HCWs) are at high risk of SARS-CoV-2 infection. Assessing the antibody status of patients with cancer and HCWs can help understand the spread of COVID-19 in cancer care.
To evaluate serum SARS-CoV-2 antibody status in patients with cancer and HCWs during the COVID-19 pandemic in Japan.
DESIGN, SETTING, AND PARTICIPANTS: Participants were enrolled for this prospective cross-sectional study between August 3 and October 30, 2020, from 2 comprehensive cancer centers in the epidemic area around Tokyo, Japan. Patients with cancer aged 16 years or older and employees were enrolled. Participants with suspected COVID-19 infection at the time of enrollment were excluded.
Cancer of any type and cancer treatment, including chemotherapy, surgery, immune checkpoint inhibitors, radiotherapy, and targeted molecular therapy.
Seroprevalence and antibody levels in patients with cancer and HCWs. Seropositivity was defined as positivity to nucleocapsid IgG (N-IgG) and/or spike IgG (S-IgG). Serum levels of SARS-CoV-2 IgM and IgG antibodies against the nucleocapsid and spike proteins were measured by chemiluminescent enzyme immunoassay.
A total of 500 patients with cancer (median age, 62.5 years [range, 21-88 years]; 265 men [55.4%]) and 1190 HCWs (median age, 40 years [range, 20-70 years]; 382 men [25.4%]) were enrolled. In patients with cancer, 489 (97.8%) had solid tumors, and 355 (71.0%) had received anticancer treatment within 1 month. Among HCWs, 385 (32.3%) were nurses or assistant nurses, 266 (22.4%) were administrative officers, 197 (16.6%) were researchers, 179 (15.0%) were physicians, 113 (9.5%) were technicians, and 50 (4.2%) were pharmacists. The seroprevalence was 1.0% (95% CI, 0.33%-2.32%) in patients and 0.67% (95% CI, 0.29%-1.32%) in HCWs (P = .48). However, the N-IgG and S-IgG antibody levels were significantly lower in patients than in HCWs (N-IgG: β, -0.38; 95% CI, -0.55 to -0.21; P < .001; and S-IgG: β, -0.39; 95% CI, -0.54 to -0.23; P < .001). Additionally, among patients, N-IgG levels were significantly lower in those who received chemotherapy than in those who did not (median N-IgG levels, 0.1 [interquartile range (IQR), 0-0.3] vs 0.1 [IQR, 0-0.4], P = .04). In contrast, N-IgG and S-IgG levels were significantly higher in patients who received immune checkpoint inhibitors than in those who did not (median N-IgG levels: 0.2 [IQR, 0.1-0.5] vs 0.1 [IQR, 0-0.3], P = .02; S-IgG levels: 0.15 [IQR, 0-0.3] vs 0.1[IQR, 0-0.2], P = .02).
In this cross-sectional study of Japanese patients with cancer and HCWs, the seroprevalence of SARS-CoV-2 antibodies did not differ between the 2 groups; however, findings suggest that comorbid cancer and treatment with systemic therapy, including chemotherapy and immune checkpoint inhibitors, may influence the immune response to SARS-CoV-2.
癌症患者和医护人员（HCWs）感染 SARS-CoV-2 的风险很高。评估癌症患者和 HCWs 的抗体状况有助于了解 COVID-19 在癌症护理中的传播。
评估 COVID-19 大流行期间日本癌症患者和 HCWs 的血清 SARS-CoV-2 抗体状况。
设计、设置和参与者：本前瞻性横断面研究于 2020 年 8 月 3 日至 10 月 30 日在日本东京周边疫区的 2 家综合癌症中心进行，纳入了参与者。纳入年龄在 16 岁及以上的癌症患者和员工。在入组时患有疑似 COVID-19 感染的患者被排除在外。
任何类型的癌症和癌症治疗，包括化疗、手术、免疫检查点抑制剂、放射治疗和靶向分子治疗。
癌症患者和 HCWs 的血清阳性率和抗体水平。血清阳性定义为核衣壳 IgG（N-IgG）和/或刺突 IgG（S-IgG）阳性。通过化学发光酶免疫分析法测量 SARS-CoV-2 IgM 和针对核衣壳和刺突蛋白的 IgG 抗体的血清水平。
共纳入 500 例癌症患者（中位年龄 62.5 岁[范围 21-88 岁]；265 例男性[55.4%]）和 1190 名 HCWs（中位年龄 40 岁[范围 20-70 岁]；382 例男性[25.4%]）。在癌症患者中，489 例（97.8%）为实体瘤患者，355 例（71.0%）在 1 个月内接受了抗癌治疗。在 HCWs 中，385 名（32.3%）为护士或助理护士，266 名（22.4%）为行政人员，197 名（16.6%）为研究人员，179 名（15.0%）为医生，113 名（9.5%）为技术员，50 名（4.2%）为药剂师。患者的血清阳性率为 1.0%（95%CI，0.33%-2.32%），HCWs 的血清阳性率为 0.67%（95%CI，0.29%-1.32%）（P=0.48）。然而，与 HCWs 相比，患者的 N-IgG 和 S-IgG 抗体水平显著降低（N-IgG：β，-0.38；95%CI，-0.55 至-0.21；P<0.001；和 S-IgG：β，-0.39；95%CI，-0.54 至-0.23；P<0.001）。此外，在患者中，与未接受化疗的患者相比，接受化疗的患者的 N-IgG 水平显著降低（中位数 N-IgG 水平，0.1[四分位距（IQR），0-0.3] vs 0.1[IQR，0-0.4]，P=0.04）。相比之下，与未接受免疫检查点抑制剂治疗的患者相比，接受免疫检查点抑制剂治疗的患者的 N-IgG 和 S-IgG 水平显著升高（中位数 N-IgG 水平：0.2[IQR，0.1-0.5] vs 0.1[IQR，0-0.3]，P=0.02；S-IgG 水平：0.15[IQR，0-0.3] vs 0.1[IQR，0-0.2]，P=0.02）。
在这项日本癌症患者和 HCWs 的横断面研究中，两组之间的 SARS-CoV-2 抗体血清阳性率没有差异；然而，研究结果表明，合并癌症和包括化疗和免疫检查点抑制剂在内的全身治疗可能会影响对 SARS-CoV-2 的免疫反应。
