Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom.
Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
JAMA Oncol. 2022 Jan 1;8(1):114-122. doi: 10.1001/jamaoncol.2021.6199.
Whether the severity and mortality of COVID-19 in patients with cancer have improved in terms of disease management and capacity is yet to be defined.
To test whether severity and mortality from COVID-19 among patients with cancer have improved during the course of the pandemic.
DESIGN, SETTING, AND PARTICIPANTS: OnCovid is a European registry that collects data on consecutive patients with solid or hematologic cancer and COVID-19. This multicenter case series study included real-world data from 35 institutions across 6 countries (UK, Italy, Spain, France, Belgium, and Germany). This update included patients diagnosed between February 27, 2020, and February, 14, 2021. Inclusion criteria were confirmed diagnosis of SARS-CoV-2 infection and a history of solid or hematologic cancer.
SARS-CoV-2 infection.
Deaths were differentiated at 14 days and 3 months as the 2 landmark end points. Patient characteristics and outcomes were compared by stratifying patients across 5 phases (February to March 2020, April to June 2020, July to September 2020, October to December 2020, and January to February 2021) and across 2 major outbreaks (February to June 2020 and July 2020 to February 2021).
At data cutoff, 2795 consecutive patients were included, with 2634 patients eligible for analysis (median [IQR] age, 68 [18-77] years ; 52.8% men). Eligible patients demonstrated significant time-dependent improvement in 14-day case-fatality rate (CFR) with estimates of 29.8% (95% CI, 0.26-0.33) for February to March 2020; 20.3% (95% CI, 0.17-0.23) for April to June 2020; 12.5% (95% CI, 0.06-22.90) for July to September 2020; 17.2% (95% CI, 0.15-0.21) for October to December 2020; and 14.5% (95% CI, 0.09-0.21) for January to February 2021 (all P < .001) across the predefined phases. Compared with the second major outbreak, patients diagnosed in the first outbreak were more likely to be 65 years or older (974 of 1626 [60.3%] vs 564 of 1008 [56.1%]; P = .03), have at least 2 comorbidities (793 of 1626 [48.8%] vs 427 of 1008 [42.4%]; P = .001), and have advanced tumors (708 of 1626 [46.4%] vs 536 of 1008 [56.1%]; P < .001). Complications of COVID-19 were more likely to be seen (738 of 1626 [45.4%] vs 342 of 1008 [33.9%]; P < .001) and require hospitalization (969 of 1626 [59.8%] vs 418 of 1008 [42.1%]; P < .001) and anti-COVID-19 therapy (1004 of 1626 [61.7%] vs 501 of 1008 [49.7%]; P < .001) during the first major outbreak. The 14-day CFRs for the first and second major outbreaks were 25.6% (95% CI, 0.23-0.28) vs 16.2% (95% CI, 0.13-0.19; P < .001), respectively. After adjusting for country, sex, age, comorbidities, tumor stage and status, anti-COVID-19 and anticancer therapy, and COVID-19 complications, patients diagnosed in the first outbreak had an increased risk of death at 14 days (hazard ratio [HR], 1.85; 95% CI, 1.47-2.32) and 3 months (HR, 1.28; 95% CI, 1.08-1.51) compared with those diagnosed in the second outbreak.
The findings of this registry-based study suggest that mortality in patients with cancer diagnosed with COVID-19 has improved in Europe; this improvement may be associated with earlier diagnosis, improved management, and dynamic changes in community transmission over time.
癌症患者 COVID-19 的严重程度和死亡率在疾病管理和能力方面是否有所改善尚待确定。
检验在大流行期间癌症患者 COVID-19 的严重程度和死亡率是否有所改善。
设计、地点和参与者：OnCovid 是一个欧洲登记处，收集了连续患有实体瘤或血液恶性肿瘤和 COVID-19 的患者的数据。这项多中心病例系列研究包括来自 6 个国家（英国、意大利、西班牙、法国、比利时和德国）的 35 个机构的真实世界数据。本更新纳入了 2020 年 2 月 27 日至 2021 年 2 月 14 日期间确诊的患者。纳入标准为 SARS-CoV-2 感染的确诊诊断和实体瘤或血液恶性肿瘤的病史。
SARS-CoV-2 感染。
将 14 天和 3 个月的死亡作为两个重要终点进行区分。通过分层患者跨越 5 个阶段（2020 年 2 月至 3 月、2020 年 4 月至 6 月、2020 年 7 月至 9 月、2020 年 10 月至 12 月和 2021 年 1 月至 2 月）和两个主要爆发（2020 年 2 月至 6 月和 2020 年 7 月至 2021 年 2 月），比较患者特征和结局。
截至数据截止日期，共纳入 2795 例连续患者，其中 2634 例符合分析条件（中位数[IQR]年龄，68[18-77]岁；52.8%为男性）。符合条件的患者在 14 天病死率（CFR）方面表现出显著的时间依赖性改善，估计值分别为 2020 年 2 月至 3 月为 29.8%（95%CI，0.26-0.33）；2020 年 4 月至 6 月为 20.3%（95%CI，0.17-0.23）；2020 年 7 月至 9 月为 12.5%（95%CI，0.06-22.90）；2020 年 10 月至 12 月为 17.2%（95%CI，0.15-0.21）；2021 年 1 月至 2 月为 14.5%（95%CI，0.09-0.21）（所有 P<0.001），跨越了预先确定的阶段。与第二次大流行相比，第一次大流行中诊断出的患者更有可能为 65 岁或以上（1626 例中的 974 例[60.3%]与 1008 例中的 564 例[56.1%]；P=0.03），至少有 2 种合并症（1626 例中的 793 例[48.8%]与 1008 例中的 427 例[42.4%]；P=0.001）和晚期肿瘤（1626 例中的 708 例[46.4%]与 1008 例中的 536 例[56.1%]；P<0.001）。更可能出现 COVID-19 并发症（1626 例中的 738 例[45.4%]与 1008 例中的 342 例[33.9%]；P<0.001）并需要住院治疗（1626 例中的 969 例[59.8%]与 1008 例中的 418 例[42.1%]；P<0.001）和抗 COVID-19 治疗（1626 例中的 1004 例[61.7%]与 1008 例中的 501 例[49.7%]；P<0.001）在第一次大流行期间。第一次和第二次大流行的 14 天 CFR 分别为 25.6%（95%CI，0.23-0.28）和 16.2%（95%CI，0.13-0.19；P<0.001）。在调整了国家、性别、年龄、合并症、肿瘤分期和状态、抗 COVID-19 和抗癌治疗以及 COVID-19 并发症后，与第二次大流行相比，第一次大流行中诊断出的患者在 14 天（危险比[HR]，1.85；95%CI，1.47-2.32）和 3 个月（HR，1.28；95%CI，1.08-1.51）时死亡的风险增加。
这项基于登记的研究结果表明，欧洲癌症患者 COVID-19 的死亡率有所改善；这种改善可能与早期诊断、改善管理以及社区传播随时间的动态变化有关。
