Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.
Equipment and Material Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.
Eur J Cancer. 2022 Sep;172:41-50. doi: 10.1016/j.ejca.2022.05.031. Epub 2022 Jun 2.
Patients with cancer presented a lower probability to obtain seroconversion after a complete course of COVID-19 vaccination. However, little was known on the factors that predict poor seroconversion in this frail population.
We searched the PubMed, EMBASE, and China National Knowledge Infrastructure databases for all articles within a range of published years from 2019 to 2022 on the predictors of response to COVID-19 vaccine in patients with cancer (last search was updated on 2st March 2022). The odds ratio corresponding to the 95% confidence interval was used to assess the outcome. The statistical heterogeneity among studies was assessed with the Q-test and I statistics. The review was registered with PROSPERO (CRD42022315687) and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Twenty cohort studies met the inclusion criteria for this study, with 5,499 patients with cancer. We found that advanced age, male patients, and metastatic disease increased negative seropositivity to COVID-19 vaccine. Immunoglobulin heavy chain variable mutation status, high concentration of Ig G, Ig M, and Ig A were correlated with seropositivity. Relating to cancer treatment strategy, anti-CD20 therapy within recent 12 months and chemotherapy were negatively correlated with seroconversion. Meta-analysis found no significant difference associated with targeted treatment, immunotherapy, and endocrine treatment.
Our meta-analysis assessed the factors that predict poor seroconversion in order to plan better prevention strategies in this frail population. The results proposed that enhanced vaccination strategies would be beneficial for the special patients such as advanced male, or patients receiving active chemotherapy, and carefully prevention should be emphasised even after a complete course of vaccination.
癌症患者在完成 COVID-19 疫苗全程接种后，发生血清转化的概率较低。然而，对于这一脆弱人群中哪些因素预测血清转化率低，目前知之甚少。
我们检索了 PubMed、EMBASE 和中国知网数据库，检索年限为 2019 年至 2022 年，收集关于癌症患者 COVID-19 疫苗反应预测因素的所有文章（最后一次检索日期为 2022 年 3 月 2 日）。使用比值比及其 95%置信区间评估结局。使用 Q 检验和 I 统计量评估研究间的统计学异质性。该综述已在 PROSPERO（CRD42022315687）注册，并按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行报告。
本研究纳入了 20 项队列研究，共纳入 5499 例癌症患者。我们发现，年龄较大、男性和转移性疾病增加了 COVID-19 疫苗的血清阴性率。免疫球蛋白重链可变区突变状态、IgG、IgM 和 IgA 浓度与血清阳性率相关。与癌症治疗策略相关，最近 12 个月内的抗 CD20 治疗和化疗与血清转化率降低相关。荟萃分析发现，靶向治疗、免疫治疗和内分泌治疗与血清转化率降低无关。
本 meta 分析评估了预测血清转化率低的因素，以便为这一脆弱人群制定更好的预防策略。结果表明，强化疫苗接种策略对男性晚期或正在接受积极化疗的特殊患者有益，即使完成了全程疫苗接种，也应强调仔细预防。
