Center for Artificial Intelligence in Drug Discovery, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Center for Science, Health, and Society, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
JAMA Oncol. 2022 Jul 1;8(7):1027-1034. doi: 10.1001/jamaoncol.2022.1096.
Limited data have been presented to examine breakthrough SARS-CoV-2 infections, hospitalizations, and mortality in vaccinated patients with cancer in the US.
To examine the risk of breakthrough SARS-CoV-2 infection, hospitalizations, and mortality in vaccinated patients with cancer between December 2020 and November 2021.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of electronic health records (EHRs) of vaccinated patients from a multicenter and nationwide database in the US during the period of December 2020 through November 2021. The study population comprised patients who had documented evidence of vaccination (2 doses of Moderna or Pfizer-BioNTech or single dose of Janssen/Johnson & Johnson vaccines) in their EHRs from December 2020 to November 2021 and had no SARS-CoV-2 infection prior to vaccination.
The 12 most common cancers combined and separately; recent vs no recent encounter for cancer; and breakthrough SARS-CoV-2 infection.
Time trends of incidence proportions of breakthrough SARS-CoV-2 infections from December 2020 to November 2021 in vaccinated patients with all cancer; cumulative risks of breakthrough infections in vaccinated patients for all cancer and 12 common cancer types; hazard ratios (HRs) and 95% CIs of breakthrough infections between propensity score-matched patients with vs without cancer and between propensity score-matched patients with cancer who had a recent medical encounter for cancer vs those who did not; overall risks, HRs, and 95% CIs of hospitalizations and mortality in patients with cancer who had breakthrough infections vs those who did not.
Among 45 253 vaccinated patients with cancer (mean [SD] age, 68.7 [12.4] years), 53.5% were female, 3.8% were Asian individuals, 15.4% were Black individuals, 4.9% were Hispanic individuals, and 74.1% were White individuals. Breakthrough SARS-CoV-2 infections in patients with cancer increased from December 2020 to November 2021 and reached 52.1 new cases per 1000 persons in November 2021. The cumulative risk of breakthrough infections in patients with all cancer was 13.6%, with highest risk for pancreatic (24.7%), liver (22.8%), lung (20.4%), and colorectal (17.5%) cancers, and lowest risk for thyroid (10.3%), endometrial (11.9%), and breast (11.9%) cancers, vs 4.9% in the noncancer population (P < .001). Patients with cancer had significantly increased risk for breakthrough infections vs patients without cancer (HR, 1.24; 95% CI, 1.19-1.29), with greatest risk for liver (HR, 1.78; 95% CI, 1.38-2.29), lung (HR, 1.73; 95% CI, 1.50-1.99), pancreatic (HR, 1.64; 95% CI, 1.24-2.18), and colorectal (HR, 1.53; 95% CI, 1.32-1.77) cancers and lowest risk for thyroid (HR, 1.07; 95% CI, 0.88-1.30) and skin (HR, 1.17; 95% CI, 0.99-1.38) cancers. Patients who had medical encounters for cancer within the past year had higher risk for breakthrough infections than those who did not (HR, 1.24; 95% CI, 1.18-1.31). Among patients with cancer, the overall risk for hospitalizations and mortality was 31.6% and 3.9%, respectively, in patients with breakthrough infections, vs 6.7% and 1.3% in those without breakthrough infections (HR for hospitalization: 13.48; 95% CI, 11.42-15.91; HR for mortality: 6.76; 95% CI, 4.97-9.20).
This cohort study showed significantly increased risks for breakthrough infection in vaccinated patients with cancer, especially those undergoing active cancer care, with marked heterogeneity among specific cancer types. Breakthrough infections in patients with cancer were associated with significant and substantial risks for hospitalizations and mortality.
在美国，关于接种疫苗的癌症患者突破性 SARS-CoV-2 感染、住院和死亡的数据有限。
研究 2020 年 12 月至 2021 年 11 月期间接种疫苗的癌症患者中突破性 SARS-CoV-2 感染、住院和死亡的风险。
设计、地点和参与者：这是一项回顾性队列研究，使用来自美国一个多中心和全国性数据库的电子健康记录（EHR），研究期间为 2020 年 12 月至 2021 年 11 月。研究人群包括在 EHR 中有记录证明接种疫苗（2 剂 Moderna 或 Pfizer-BioNTech 或 Janssen/Johnson & Johnson 疫苗）且在接种疫苗前没有 SARS-CoV-2 感染的患者。
12 种最常见的癌症合并和单独；癌症的近期 vs 非近期就诊；以及突破性 SARS-CoV-2 感染。
2020 年 12 月至 2021 年 11 月期间所有癌症患者接种疫苗后突破性 SARS-CoV-2 感染的发病率比例的时间趋势；所有癌症和 12 种常见癌症类型接种疫苗患者突破性感染的累积风险；癌症患者与无癌症患者匹配后、癌症患者近期就诊与无近期就诊患者匹配后突破性感染的风险比（HR）和 95%置信区间（CI）；突破性感染患者与未感染患者相比的住院和死亡的总体风险、HR 和 95%CI。
在 45253 例接种疫苗的癌症患者（平均[SD]年龄，68.7[12.4]岁）中，53.5%为女性，3.8%为亚洲人，15.4%为黑人，4.9%为西班牙裔，74.1%为白人。癌症患者的突破性 SARS-CoV-2 感染从 2020 年 12 月到 2021 年 11 月有所增加，11 月达到每 1000 人 52.1 例新发病例。所有癌症患者突破性感染的累积风险为 13.6%，胰腺癌（24.7%）、肝癌（22.8%）、肺癌（20.4%）和结直肠癌（17.5%）风险最高，甲状腺癌（10.3%）、子宫内膜癌（11.9%）和乳腺癌（11.9%）风险最低，而非癌症人群的风险为 4.9%（P<.001）。与无癌症患者相比，癌症患者突破性感染的风险显著增加（HR，1.24；95%CI，1.19-1.29），肝癌（HR，1.78；95%CI，1.38-2.29）、肺癌（HR，1.73；95%CI，1.50-1.99）、胰腺癌（HR，1.64；95%CI，1.24-2.18）和结直肠癌（HR，1.53；95%CI，1.32-1.77）风险最高，甲状腺癌（HR，1.07；95%CI，0.88-1.30）和皮肤癌（HR，1.17；95%CI，0.99-1.38）风险最低。在过去 1 年内有癌症就诊的患者与无就诊的患者相比，突破性感染的风险更高（HR，1.24；95%CI，1.18-1.31）。在癌症患者中，突破性感染患者的住院和死亡率分别为 31.6%和 3.9%，而无突破性感染患者的住院和死亡率分别为 6.7%和 1.3%（住院 HR：13.48；95%CI，11.42-15.91；死亡 HR：6.76；95%CI，4.97-9.20）。
这项队列研究显示，接种疫苗的癌症患者突破性感染的风险显著增加，尤其是正在接受癌症治疗的患者，不同癌症类型之间存在显著的异质性。癌症患者的突破性感染与住院和死亡的显著和实质性风险相关。
