Oncology Institute Prof Dr Ion Chiricuta, Cluj-Napoca, Romania; Iuliu Haţieganu University of Medicine and Pharmacy Oncology, Cluj-Napoca, Romania.
Oncology Institute Prof Dr Ion Chiricuta, Cluj-Napoca, Romania.
ESMO Open. 2022 Apr;7(2):100423. doi: 10.1016/j.esmoop.2022.100423. Epub 2022 Feb 10.
The evolution of COVID-19 is a controversial topic in cancer patients. They have been designated by international organizations as a vulnerable population at greater risk for contracting SARS-CoV-2 and having a more severe clinical outcome.
Active screening at our institution became routine early in the pandemic. We have examined the clinical data of 341 cancer patients, with a positive RT-PCR SARS-CoV-2 test between April 2020 and February 2021, in the prevaccination era.
During the infection, 40.5% remained asymptomatic, 27.6% developed a mild form, 20.5% had a moderate form, and 11.4% a severe/critical form of COVID-19 that led to death in 7.6% of cases. Treatment was adapted to disease severity according to national guidelines. In our series, the incidence of COVID-19 infection was lower in cancer patients compared with the general population (P < 0.001), however, the mortality rate was higher in cancer patients in comparison with the general population (7.6% versus 2.9%, P < 0.001). The prognostic factors were assessed by three distinct univariate and multivariate analyses: (i) evolution to a moderate or severe/critical clinical manifestation, (ii) clinical worsening (severe/critical form or death), and (iii) overall survival. In the multivariate analysis, the prognostic factors associated with the evolution to a moderate or severe/critical clinical manifestation were: performance status (PS) (P < 0.0001) and no active treatment in the previous 3 months (P = 0.031). Factors associated with clinical worsening were: PS (P < 0.0001), peripheral arterial disease (P = 0.03), and chronic liver disease (P = 0.04). Factors associated with impaired overall survival were PS (P < 0.0001), ischemic cardiac disease (P = 0.0126), chronic liver disease (P = 0.001), and radiotherapy (P = 0.0027).
Our series confirms a more severe evolution for COVID-19 infection in cancer patients, with PS as the most prominent prognostic factor in all three multivariate analyses. By active screening, efforts should be in place to keep cancer units as coronavirus-free sanctuaries.
COVID-19 在癌症患者中的演变是一个有争议的话题。国际组织将他们指定为更容易感染 SARS-CoV-2 并出现更严重临床结果的脆弱人群。
在大流行早期，我们机构就开始进行主动筛查。我们检查了 2020 年 4 月至 2021 年 2 月期间在疫苗接种前时代，341 名 RT-PCR SARS-CoV-2 检测呈阳性的癌症患者的临床数据。
在感染期间，40.5%的患者无症状，27.6%的患者为轻症，20.5%的患者为中度症状，11.4%的患者为重症/危重症 COVID-19，其中 7.6%的患者死亡。根据国家指南，我们根据疾病严重程度调整了治疗方法。在我们的系列中，癌症患者 COVID-19 感染的发生率低于普通人群（P<0.001），但癌症患者的死亡率高于普通人群（7.6%比 2.9%，P<0.001）。通过三个不同的单变量和多变量分析评估了预后因素：（i）发展为中度或重度/危重症临床表现，（ii）临床恶化（重症/危重症或死亡），和（iii）总生存。在多变量分析中，与发展为中度或重度/危重症临床表现相关的预后因素是：表现状态（PS）（P<0.0001）和前 3 个月无积极治疗（P=0.031）。与临床恶化相关的因素是：PS（P<0.0001）、外周动脉疾病（P=0.03）和慢性肝病（P=0.04）。与总生存受损相关的因素是 PS（P<0.0001）、缺血性心脏病（P=0.0126）、慢性肝病（P=0.001）和放疗（P=0.0027）。
我们的系列证实了癌症患者 COVID-19 感染的更严重演变，PS 是所有三种多变量分析中最突出的预后因素。通过主动筛查，应努力使癌症病房成为无冠状病毒的避难所。
