Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
Center for Human Genetics, Universitatsklinikum Giessen und Marburg - Standort Marburg, 35055 Marburg, Germany.
Vaccine. 2023 Mar 10;41(11):1791-1798. doi: 10.1016/j.vaccine.2023.01.072. Epub 2023 Feb 13.
Solid cancer patients following SARS-CoV-2 vaccination are likely to have a lower seroconversion rate than healthy adults. Seroconversion between those with and without cancer is likely to vary moderately or to be restricted to specific subgroups. Therefore, we sought to conduct a systematic review and meta-analysis to identify risk factors for diminished humoral immune responses in solid cancer patients.
MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were used to search literature through May 1, 2022. Prospective or retrospective studies comparing responders with non-responders against SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) following COVID-19 vaccination were included. Pooled Odds Ratios (pORs) with 95% CIs for binary variables and differences in means (with SDs) for continuous variables were calculated to determine the pooled effect estimates of risk factors for poor antibody response.
Fifteen studies enrolling 3593 patients were included in the analysis. Seroconversion was seen in 84% of the pooled study population. Male gender, age >65 years, and recent chemotherapy were all factors in a poor immune response. Patients under follow-up, those who received immunotherapy or targeted therapy, were more likely to be seropositive. Cancer subtypes, vaccine types, and timing of antibody testing from the 2nd dose of vaccine did not correlate with seroconversion.
Cytotoxic therapy for solid cancer may portend poor immune response following 2 doses of COVID-19 vaccines suggesting a need for booster doses in these patients. Immunotherapy and targeted therapy are likely to be associated with seropositive status, and thus can be considered as an alternative to cytotoxic agents in cases where both therapies are equally efficacious.
接种 SARS-CoV-2 疫苗后患有实体瘤的患者血清转化率可能低于健康成年人。癌症患者与非癌症患者之间的血清转化率可能存在中度差异，或者仅限于特定亚组。因此，我们试图进行系统评价和荟萃分析，以确定实体瘤患者体液免疫反应减弱的危险因素。
使用 MEDLINE、Embase、Web of Science、Cochrane Library 和 ClinicalTrials.gov 数据库，于 2022 年 5 月 1 日之前检索文献。纳入比较 COVID-19 疫苗接种后 SARS-CoV-2 刺突（S）蛋白受体结合域（RBD）抗体应答者与无应答者的前瞻性或回顾性研究。计算二分类变量的合并优势比（pOR）及其 95%可信区间和连续变量的均数差异（标准差），以确定不良抗体反应的危险因素的合并效应估计值。
共纳入 15 项研究，共计 3593 例患者。研究人群中 84%发生了血清转化。男性、年龄>65 岁和近期化疗均为免疫反应不良的因素。正在随访的患者、接受免疫治疗或靶向治疗的患者更有可能呈血清阳性。癌症亚型、疫苗类型和第 2 剂疫苗后抗体检测时间与血清转化率无相关性。
针对实体瘤的细胞毒性治疗可能预示着 COVID-19 疫苗接种后免疫反应不佳，提示这些患者需要加强接种。免疫治疗和靶向治疗可能与血清阳性状态相关，因此在两种治疗方法同样有效的情况下，可考虑替代细胞毒性药物。
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