Cancer Medicine Department, Gustave Roussy, Paris-Saclay University, Paris, France.
Biostatistics Department, Gustave Roussy, Paris-Saclay University, Paris, France.
Nat Cancer. 2020 Oct;1(10):965-975. doi: 10.1038/s43018-020-00120-5. Epub 2020 Sep 22.
Patients with cancer are presumed to be at increased risk of severe COVID-19 outcomes due to underlying malignancy and treatment-induced immunosuppression. Of the first 178 patients managed for COVID-19 at the Gustave Roussy Cancer Centre, 125 (70.2%) were hospitalized, 47 (26.4%) developed clinical worsening and 31 (17.4%) died. An age of over 70 years, smoking status, metastatic disease, cytotoxic chemotherapy and an Eastern Cooperative Oncology Group score of ≥2 at the last visit were the strongest determinants of increased risk of death. In multivariable analysis, the Eastern Cooperative Oncology Group score remained the only predictor of death. In contrast, immunotherapy, hormone therapy and targeted therapy did not increase clinical worsening or death risk. Biomarker studies found that C-reactive protein and lactate dehydrogenase levels were significantly associated with an increased risk of clinical worsening, while C-reactive protein and D-dimer levels were associated with an increased risk of death. COVID-19 management impacted the oncological treatment strategy, inducing a median 20 d delay in 41% of patients and adaptation of the therapeutic strategy in 30% of patients.
由于潜在的恶性肿瘤和治疗引起的免疫抑制，癌症患者被认为有发生 COVID-19 重症的风险增加。在 Gustave Roussy 癌症中心管理的 178 名 COVID-19 患者中，125 名（70.2%）住院，47 名（26.4%）出现临床恶化，31 名（17.4%）死亡。年龄超过 70 岁、吸烟状况、转移性疾病、细胞毒性化疗和最后一次就诊时的东部合作肿瘤学组评分≥2 是死亡风险增加的最强决定因素。多变量分析显示，东部合作肿瘤学组评分仍然是死亡的唯一预测因素。相比之下，免疫疗法、激素疗法和靶向疗法并未增加临床恶化或死亡风险。生物标志物研究发现，C 反应蛋白和乳酸脱氢酶水平与临床恶化风险增加显著相关，而 C 反应蛋白和 D-二聚体水平与死亡风险增加相关。COVID-19 的管理影响了肿瘤治疗策略，导致 41%的患者治疗延迟中位数为 20 天，并使 30%的患者调整了治疗策略。
