The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia.
Directorate General for Health, Lombardy Region, Milano, Italy; Environmental Health Unit, Agency for Health Protection, Pavia, Italy.
J Cancer Policy. 2022 Sep;33:100340. doi: 10.1016/j.jcpo.2022.100340. Epub 2022 Jun 6.
Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer.
We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59-4.20, adjusted OR=1.37,95%CI:1.16-1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33-2.08; five studies, adjusted HR=1.19,95%CI:1.02-1.38).
The initial evidence (published to 1 July 2020) on COVID-19-related death in people with cancer is characterised by multiple sources of bias and substantial overlap between data included in different studies. Pooled analyses of non-overlapping early data with adjustment for at least age indicated a significantly increased risk of COVID-19-related death for those with a pre-existing cancer diagnosis.
早期报告表明，患有癌症的 COVID-19 患者因 COVID-19 相关死亡的风险更高。我们进行了一项系统评价，对 COVID-19 患者中伴有和不伴有癌症的 COVID-19 相关死亡风险的早期证据进行了风险偏倚评估和综合分析。
我们检索了 Medline/Embase/BioRxiv/MedRxiv/SSRN 数据库至 2020 年 7 月 1 日。我们纳入了以英文发表的队列或病例对照研究，这些研究报告了在患有任何癌症、肺癌或血液系统癌症的预先诊断后发生 COVID-19 后死亡的风险。我们使用了来自纽卡斯尔-渥太华量表的工具来评估风险偏倚。我们使用通用逆方差随机效应方法进行荟萃分析。分别计算合并的优势比（OR）和风险比（HR）。在 96 项纳入的研究中，有 54 项具有足够的非重叠数据可进行荟萃分析（超过 50 万例 COVID-19 患者，超过 8000 例癌症患者；52 项研究为任何癌症，3 项为肺癌，6 项为血液系统癌症）。所有研究均存在高偏倚风险。一致考虑至少年龄因素会导致癌症患者 COVID-19 相关死亡的估计 OR 和 HR 降低（例如，任何癌症与无癌症；6 项研究，未调整的 OR=3.30，95%CI：2.59-4.20，调整后的 OR=1.37，95%CI：1.16-1.61）。未报告针对肺癌或血液系统癌症患者的调整后效应估计值。在 18 项至少调整了年龄的研究中，有 17 项报告了预先存在的癌症诊断与 COVID-19 相关死亡之间存在正相关（例如，任何癌症与无癌症；9 项研究，调整后的 OR=1.66，95%CI：1.33-2.08；5 项研究，调整后的 HR=1.19，95%CI：1.02-1.38）。
截至 2020 年 7 月 1 日，有关癌症患者 COVID-19 相关死亡的初步证据（发表至该日期）具有多种偏倚来源，并且不同研究中包含的数据存在大量重叠。对至少调整了年龄的非重叠早期数据进行的汇总分析表明，预先存在癌症诊断的患者 COVID-19 相关死亡的风险显著增加。
