Division of Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
CancerLinQ, American Society of Clinical Oncology, Alexandria, VA.
JCO Oncol Pract. 2022 Aug;18(8):e1265-e1277. doi: 10.1200/OP.22.00064.
Understanding risks for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and subsequent mortality among patients with cancer may help inform treatment decisions during the COVID-19 pandemic.
CancerLinQ is an electronic health record database from US oncology practices. We identified a cohort of patients with malignancy and 2+ encounters at CancerLinQ practices in the 12 months before the study period (January 1, 2020-January 31, 2021). We identified a SARS-CoV-2 subcohort as having a positive SARS-CoV-2 test or International Classification of Diseases, 10th Revision, code. We examined predictors of SARS-CoV-2 infection and mortality including sex, race, ethnicity, age, malignancy type, and prior therapy. Unadjusted and adjusted incidence rate ratios (aIRRs) and 95% CIs were estimated from Poisson regression models for SARS-CoV-2 infections and mortality.
The cancer cohort included 629,128 patients, and the SARS-CoV-2 subcohort included 12,300 patients. Higher incidence of SARS-CoV-2 was seen among patients who were male (incidence rate ratio [IRR], 1.14; 95% CI, 1.10 to 1.18), Black (IRR, 1.48; 95% CI, 1.41 to 1.56), Hispanic (IRR, 2.02; 95% CI, 1.91 to 2.14), age < 50 years (IRR, 1.34; 95% CI, 1.26 to 1.42), with hematologic malignancies (IRR, 1.07; 95% CI, 1.02 to 1.12), and with recent chemotherapy (IRR, 1.30, 95% CI, 1.22 to 1.40). In the adjusted analysis, higher incidence was seen in patients who were male (aIRR, 1.17; 95% CI, 1.13 to 1.21), Hispanic (aIRR, 2.01; 95% CI, 1.88 to 2.14), and with recent chemotherapy (aIRR, 1.17; 95% CI, 1.09 to 1.25). There were 182 all-cause deaths within the SARS-CoV-2 subcohort. Higher mortality was seen among patients who were male (IRR, 1.39; 95% CI, 1.04 to 1.86), unknown race (IRR, 2.64; 95% CI, 1.42 to 4.91), other/unknown ethnicity (IRR, 1.99; 95% CI, 1.20 to 3.29), age 60-69 years (IRR, 2.76; 95% CI, 1.23 to 6.19), age 70-79 years (IRR, 5.28; 95% CI, 2.42 to 11.5), age 80+ years (IRR, 7.31; 95% CI, 3.31 to 16.1), or with recent chemotherapy (IRR, 1.52, 95% CI, 1.01 to 2.29). In the adjusted analysis, higher mortality was seen with increased age and receipt of chemotherapy.
Patients with increased risk of SARS-CoV-2 infection must balance the competing risks of their cancer diagnosis/treatment and SARS-CoV-2 infection.
了解癌症患者感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）和随后死亡的风险，可能有助于在 COVID-19 大流行期间为治疗决策提供信息。
CancerLinQ 是美国肿瘤学实践中的电子健康记录数据库。我们确定了一个患有恶性肿瘤且在研究期间前 12 个月（2020 年 1 月 1 日-2021 年 1 月 31 日）在 CancerLinQ 实践中有 2 次以上就诊的恶性肿瘤患者队列。我们将 SARS-CoV-2 亚队列确定为 SARS-CoV-2 检测呈阳性或国际疾病分类第 10 次修订版代码。我们研究了包括性别、种族、民族、年龄、恶性肿瘤类型和既往治疗在内的 SARS-CoV-2 感染和死亡率的预测因素。使用泊松回归模型估计了 SARS-CoV-2 感染和死亡率的未调整和调整后的发病率比（aIRR）和 95%置信区间。
癌症队列包括 629128 名患者，SARS-CoV-2 亚队列包括 12300 名患者。男性（发病率比 [IRR]，1.14；95%CI，1.10 至 1.18）、黑人（IRR，1.48；95%CI，1.41 至 1.56）、西班牙裔（IRR，2.02；95%CI，1.91 至 2.14）、年龄<50 岁（IRR，1.34；95%CI，1.26 至 1.42）、血液恶性肿瘤（IRR，1.07；95%CI，1.02 至 1.12）和近期化疗（IRR，1.30，95%CI，1.22 至 1.40）患者的 SARS-CoV-2 感染发生率更高。在调整分析中，男性（aIRR，1.17；95%CI，1.13 至 1.21）、西班牙裔（aIRR，2.01；95%CI，1.88 至 2.14）和近期化疗（aIRR，1.17；95%CI，1.09 至 1.25）患者的感染发生率更高。SARS-CoV-2 亚队列中有 182 例全因死亡。男性（IRR，1.39；95%CI，1.04 至 1.86）、未知种族（IRR，2.64；95%CI，1.42 至 4.91）、其他/未知民族（IRR，1.99；95%CI，1.20 至 3.29）、年龄 60-69 岁（IRR，2.76；95%CI，1.23 至 6.19）、年龄 70-79 岁（IRR，5.28；95%CI，2.42 至 11.5）、年龄 80 岁及以上（IRR，7.31；95%CI，3.31 至 16.1）或接受近期化疗（IRR，1.52，95%CI，1.01 至 2.29）患者的死亡率更高。在调整分析中，随着年龄的增加和接受化疗，死亡率更高。
感染 SARS-CoV-2 风险增加的患者必须平衡癌症诊断/治疗和 SARS-CoV-2 感染的竞争风险。
