Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
Curr Oncol. 2024 Mar 19;31(3):1562-1571. doi: 10.3390/curroncol31030119.
The effect of COVID-19 on treatment outcomes in the literature remains limited and is mostly reported either as predictive survival using prioritization and modeling techniques. We aimed to quantify the effect of COVID-19 on lung cancer survival using real-world data collected at the Jewish General Hospital, Montreal. This is a retrospective chart review study of patients diagnosed between March 2019 and March 2022. We compared three cohorts: pre-COVID-19, and 1st and 2nd year of the pandemic. 417 patients were diagnosed and treated with lung cancer at our centre: 130 in 2019, 103 in 2020 and 184 in 2021. Although the proportion of advanced/metastatic-stage lung cancer remained the same, there was a significant increase in the late-stage presentation during the pandemic. The proportion of M1c (multiple extrathoracic sites) cases in 2020 and 2021 was 57% and 51%, respectively, compared to 31% in 2019 ( < 0.05). Median survival for early stages of lung cancer was similar in the three cohorts. However, patients diagnosed in the M1c stage had a significantly increased risk of death. The 6-month mortality rate was 53% in 2021 compared to 47% in 2020 and 29% in 2019 ( = 0.004). The median survival in this subgroup of patients decreased significantly from 13 months in 2019 to 6 months in 2020 and 5 months in 2021 ( < 0.001). This study is, to our knowledge, the largest single-institution study in Canada looking at lung cancer survival during the COVID-19 pandemic. Our study looks at overall survival in the advanced/metastatic setting of NSCLC during the COVID-19 pandemic. We have previously reported on treatment pattern changes and increased wait times for NSCLC patients during the pandemic. In this study, we report that the advanced/metastatic subgroup had both an increase in the 6-month mortality rate and worsening overall survival during this same time period. Although there was no statistical difference in the proportion of patients with advanced disease, there was a concerning trend of increased M1c disease in cohorts 2 and 3. The higher M1c disease during the COVID-19 pandemic (cohorts 2 and 3) likely played a crucial role in increasing the 6-month mortality rate and leading to a reduced overall survival of lung cancer patients during the pandemic. These findings are more likely to be better identified with longer follow-up.
COVID-19 对文献中治疗结果的影响仍然有限，并且大多是通过使用优先级和建模技术预测生存情况来报告的。我们旨在使用在蒙特利尔犹太综合医院收集的真实世界数据来量化 COVID-19 对肺癌生存的影响。这是一项对 2019 年 3 月至 2022 年 3 月期间诊断为肺癌的患者进行的回顾性图表审查研究。我们比较了三个队列：COVID-19 之前、大流行的第 1 年和第 2 年。我们中心共诊断和治疗了 417 名肺癌患者：2019 年 130 名，2020 年 103 名，2021 年 184 名。尽管晚期/转移性肺癌的比例保持不变，但大流行期间晚期肺癌的就诊比例显著增加。2020 年和 2021 年 M1c（多个胸外部位）病例的比例分别为 57%和 51%，而 2019 年为 31%（<0.05）。三组肺癌早期患者的中位生存期相似。然而，在 M1c 期诊断的患者死亡风险显著增加。2021 年 6 个月死亡率为 53%，而 2020 年为 47%，2019 年为 29%（=0.004）。这一亚组患者的中位生存期从 2019 年的 13 个月显著下降至 2020 年的 6 个月和 2021 年的 5 个月（<0.001）。据我们所知，这项研究是加拿大最大的单中心研究，探讨了 COVID-19 大流行期间的肺癌生存率。我们的研究着眼于 COVID-19 大流行期间非小细胞肺癌（NSCLC）晚期/转移性环境中的总生存率。我们之前曾报道过 NSCLC 患者在大流行期间治疗模式的变化和等待时间的延长。在这项研究中，我们报告说，在同一时期，晚期/转移性亚组的 6 个月死亡率和总体生存率都有所恶化。尽管晚期疾病患者的比例没有统计学差异，但在第 2 组和第 3 组中，M1c 疾病的趋势令人担忧。COVID-19 大流行期间（第 2 组和第 3 组）更高的 M1c 疾病可能在增加 6 个月死亡率和导致肺癌患者整体生存率降低方面发挥了关键作用。随着随访时间的延长，这些发现可能更容易被识别。
