Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston.
JAMA Oncol. 2022 Jan 1;8(1):69-78. doi: 10.1001/jamaoncol.2021.5148.
As the COVID-19 pandemic continues, understanding the clinical outcomes of patients with cancer and COVID-19 has become critically important.
To compare the outcomes of patients with or without cancer who were diagnosed with COVID-19 and to identify the factors associated with mortality, mechanical ventilation, intensive care unit (ICU) stay, and hospitalization.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained data from the Optum de-identified COVID-19 electronic health record data set. More than 500 000 US adults who were diagnosed with COVID-19 from January 1 to December 31, 2020, were analyzed.
The patient groups were (1) patients without cancer, (2) patients with no recent cancer treatment, and (3) patients with recent cancer treatment (within 3 months before COVID-19 diagnosis) consisting of radiation therapy or systemic therapy.
Mortality, mechanical ventilation, ICU stay, and hospitalization within 30 days of COVID-19 diagnosis were the main outcomes. Unadjusted rates and adjusted odds ratios (ORs) of adverse outcomes were presented according to exposure group.
A total of 507 307 patients with COVID-19 were identified (mean [SD] age, 48.4 [18.4] years; 281 165 women [55.4%]), of whom 493 020 (97.2%) did not have cancer. Among the 14 287 (2.8%) patients with cancer, 9991 (69.9%) did not receive recent treatment and 4296 (30.1%) received recent treatment. In unadjusted analyses, patients with cancer, regardless of recent treatment received, were more likely to have adverse outcomes compared with patients without cancer (eg, mortality rate: 1.6% for patients without cancer, 5.0% for patients with no recent cancer treatment, and 7.8% for patients with recent cancer treatment). After adjustment, patients with no recent cancer treatment had similar or better outcomes than patients without cancer (eg, mortality OR, 0.93 [95% CI, 0.84-1.02]; mechanical ventilation OR, 0.61 [95% CI, 0.54-0.68]). In contrast, a higher risk of death (OR, 1.74; 95% CI, 1.54-1.96), ICU stay (OR, 1.69; 95% CI, 1.54-1.87), and hospitalization (OR, 1.19; 95% CI, 1.11-1.27) was observed in patients with recent cancer treatment. Compared with patients with nonmetastatic solid tumors, those with metastatic solid tumors and hematologic malignant neoplasms had worse outcomes (eg, mortality OR, 2.36 [95% CI, 1.96-2.84]; mechanical ventilation OR, 0.87 [95% CI, 0.70-1.08]). Recent chemotherapy and chemoimmunotherapy were also associated with worse outcomes (eg, chemotherapy mortality OR, 1.84 [95% CI, 1.51-2.26]).
This cohort study found that patients with recent cancer treatment and COVID-19 had a significantly higher risk of adverse outcomes, and patients with no recent cancer treatment had similar outcomes to those without cancer. The findings have risk stratification and resource use implications for patients, clinicians, and health systems.
随着 COVID-19 大流行的持续，了解癌症患者的临床结局变得至关重要。
比较确诊 COVID-19 的癌症患者和非癌症患者的结局，并确定与死亡率、机械通气、重症监护病房（ICU）入住和住院相关的因素。
设计、设置和参与者：本队列研究从 Optum 去标识 COVID-19 电子健康记录数据集获取数据。对 2020 年 1 月 1 日至 12 月 31 日期间，50 多万名美国成年人进行了分析。
患者组为（1）无癌症患者，（2）无近期癌症治疗的患者，以及（3）近期接受癌症治疗（COVID-19 诊断前 3 个月内）的患者，包括放射治疗或全身治疗。
30 天内 COVID-19 诊断后的死亡率、机械通气、ICU 入住和住院为主要结局。根据暴露组，呈现未调整的不良结局发生率和调整后的比值比（OR）。
共确定了 507307 名 COVID-19 患者（平均[SD]年龄，48.4[18.4]岁；281165 名女性[55.4%]），其中 493020 名（97.2%）无癌症。在 14287 名（2.8%）癌症患者中，9991 名（69.9%）未接受近期治疗，4296 名（30.1%）接受近期治疗。在未调整的分析中，与无癌症患者相比，无论近期治疗是否接受，癌症患者更有可能出现不良结局（例如，死亡率：无癌症患者为 1.6%，无近期癌症治疗的患者为 5.0%，近期接受癌症治疗的患者为 7.8%）。调整后，无近期癌症治疗的患者的结局与无癌症患者相似或更好（例如，死亡率 OR，0.93[95%CI，0.84-1.02]；机械通气 OR，0.61[95%CI，0.54-0.68]）。相比之下，近期接受癌症治疗的患者死亡风险（OR，1.74；95%CI，1.54-1.96）、ICU 入住（OR，1.69；95%CI，1.54-1.87）和住院（OR，1.19；95%CI，1.11-1.27）的风险更高。与非转移性实体瘤患者相比，转移性实体瘤和血液恶性肿瘤患者的结局更差（例如，死亡率 OR，2.36[95%CI，1.96-2.84]；机械通气 OR，0.87[95%CI，0.70-1.08]）。近期化疗和化疗免疫治疗也与更差的结局相关（例如，化疗死亡率 OR，1.84[95%CI，1.51-2.26]）。
本队列研究发现，近期接受癌症治疗和 COVID-19 的患者发生不良结局的风险显著更高，而无近期癌症治疗的患者与无癌症患者的结局相似。研究结果对患者、临床医生和卫生系统具有风险分层和资源利用的意义。
