Department of Hematology and SCT, Santa Maria della Misericordia Hospital, ASUFC, Udine, Italy.
Department of Oncology, Santa Maria della Misericordia Hospital, ASUFC, Udine, Italy.
PLoS One. 2022 Feb 2;17(2):e0262784. doi: 10.1371/journal.pone.0262784. eCollection 2022.
Even if now we have available the weapon of vaccination against SARS-CoV-2, the patients with cancer remains a very frail population in which frequently the immunologic response to vaccination may be impaired. In this setting, the SARS-CoV-2 infection screening retains a great value. However, there are still limited data on the feasibility and efficacy of combined screening procedures to assess the prevalence of SARS-CoV-2 infection (including asymptomatic cases) in cancer outpatients undergoing antineoplastic therapy.
From May 1, 2020, to June 15, 2020, during the first wave of SARS-CoV-2 pandemic, 860 consecutive patients, undergoing active anticancer therapy, were evaluated and tested for SARS-CoV-2 with a combined screening procedure, including a self-report questionnaire, a molecular nasopharyngeal swab (NPS) and a rapid serological immunoassay (for anti-SARS-CoV-2 IgG/IgM antibodies). The primary endpoint of the study was to estimate the prevalence of SARS-CoV-2 infection (including asymptomatic cases) in consecutive and unselected cancer outpatients by a combined screening modality. A total of 2955 SARS-CoV-2 NPS and 860 serological tests, in 475 patients with hematologic cancers and in 386 with solid tumors, were performed. A total of 112 (13%) patients self-reported symptoms potentially COVID-19 related. In 1/860 cases (< 1%) SARS-CoV-2 NPS was positive and in 14 cases (1.62%) the specific serological test was positive (overall prevalence of SARS-CoV-2 infection 1.62%). Of the 112 cases who declared symptoms potentially COVID-19-related, only 2.7% (3/112) were found SARS-CoV-2 positive.
This is the largest study reporting the feasibility of a combined screening procedure (including triage, NPS and serologic test) to evaluate the prevalence of SARS-CoV-2 infection in cancer patients receiving active therapy, during the first epidemic wave and under the restrictive lockdown measures, in one of the active areas of the SARS-CoV-2 circulation. Lacking specific recommendations for the detection of asymptomatic SARS-CoV-2 cases, a combined diagnostic screening might be more effective to detect the exact prevalence of SARS-CoV-2 in neoplastic patient population. The prevalence can obviously change according to the territorial context, the entity of the restrictive measures adopted and the phase of the epidemic curve. However, its exact and real-time knowledge could be important to balance risks/benefits of oncologic treatments, avoiding (if the prevalence is low) the reduction of dose intensity or the selection of less intensive (but also less effective) anti-cancer therapies.
即使现在我们有针对 SARS-CoV-2 的疫苗武器，癌症患者仍然是一个非常脆弱的群体，他们的免疫反应常常可能受到损害。在这种情况下，SARS-CoV-2 感染筛查仍然具有重要价值。然而，关于联合筛查程序评估接受抗肿瘤治疗的癌症门诊患者 SARS-CoV-2 感染（包括无症状病例）患病率的可行性和疗效的数据仍然有限。
从 2020 年 5 月 1 日至 6 月 15 日，在 SARS-CoV-2 大流行的第一波期间，对 860 例连续接受主动抗肿瘤治疗的患者进行了评估，并通过联合筛查程序（包括自我报告问卷、鼻咽拭子分子检测（NPS）和快速血清学免疫测定（用于抗 SARS-CoV-2 IgG/IgM 抗体）检测 SARS-CoV-2。研究的主要终点是通过联合筛查方式估计连续和未选择的癌症门诊患者中 SARS-CoV-2 感染（包括无症状病例）的患病率。在 475 例血液系统癌症患者和 386 例实体瘤患者中，共进行了 2955 次 SARS-CoV-2 NPS 和 860 次血清学检测。有 112 例（13%）患者自我报告了与 COVID-19 相关的潜在症状。在 860 例病例中，有 1 例（<1%）NPS 检测 SARS-CoV-2 呈阳性，有 14 例（1.62%）特定血清学检测呈阳性（SARS-CoV-2 总感染率为 1.62%）。在报告有潜在 COVID-19 相关症状的 112 例患者中，只有 2.7%（3/112）检测到 SARS-CoV-2 阳性。
这是最大的一项研究报告，介绍了联合筛查程序（包括分诊、NPS 和血清学检测）评估在 SARS-CoV-2 传播活跃地区之一，在第一波大流行期间和严格封锁措施下，接受积极治疗的癌症患者中 SARS-CoV-2 感染的患病率的可行性。由于缺乏对无症状 SARS-CoV-2 病例的检测的具体建议，联合诊断筛查可能更有效地检测肿瘤患者人群中 SARS-CoV-2 的真实患病率。患病率显然会根据地域背景、采取的限制措施的性质和流行曲线的阶段而变化。然而，实时了解其确切情况可能对于平衡肿瘤治疗的风险/获益很重要，避免（如果患病率较低）降低剂量强度或选择不那么密集（但也不那么有效）的抗癌治疗。
