Rini Brian I, Best Ana F, Bowman Mel D, Mishkin Grace E, Denicoff Andrea M, Rubinstein Larry V, Harris Lyndsay, Geiger Ann M, Mark Nicholas M, Pergam Steven A, Warner Jeremy L, Khorana Alok A, Gnjatic Sacha, Yen Tina W F, Liles Darla K, Bestvina Christine M, Shah Neil J, Norrell Jacqueline T, Hershman Dawn L, Holter-Chakrabarty Jennifer L, Poklepovic Andrew S, Chanock Stephen J, Sankaran Hari, Korde Larissa A
Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
JAMA Oncol. 2025 Jul 17. doi: 10.1001/jamaoncol.2025.2010.
Retrospective case series have identified having cancer and receiving treatment for cancer as risk factors for inferior COVID-19 outcomes.
To determine risk factors for hospitalization and death in patients with cancer with COVID-19 infection.
DESIGN, SETTING, AND PARTICIPANTS: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) is a prospective longitudinal natural history cohort study examining the impact of COVID-19 on patients with cancer. Adults were eligible within 14 days of an initial positive SARS-CoV-2 test result if they were receiving active treatment for cancer or had prior stem cell/bone marrow transplant or CAR T-cell treatment. The statistical analysis took place between September 2024 and April 2025.
The primary objective of the study was to determine patient factors, therapy types, and cancer types associated with COVID-19 severity, defined as hospitalization for or death from COVID-19 within 30 and 90 days after the first positive SARS-CoV-2 test result. Multivariable regressions were performed for COVID-19-specific hospitalization and mortality (proportional hazard and cause-specific hazard models).
Of 1572 eligible adult patients (median [range] age, 60 [18-93] years; 840 female [53.4%]), 1066 (67.8%) had a solid tumor, with 683 (64.0%) having metastatic disease; breast (252 [23.6%]) and lung cancer (148 [13.9%]) were most common. At enrollment, 1013 patients (64.4%) were unvaccinated for SARS-CoV-2. COVID-19-related mortality at 90 days was 3.0% and did not increase at subsequent time points. The cumulative incidence of COVID-19-specific death in the first 90 days was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and lowest in patients with other solid tumors and other hematologic cancers. In multivariable analysis, receipt of chemotherapy (hazard ratio [HR], 1.97; 95% CI, 1.52-2.54) and baseline history of stroke, atrial fibrillation, or pulmonary embolism (HR, 1.78; 95% CI, 1.33-2.38) were associated with a higher risk of hospitalization. Vaccination prior to SARS-CoV-2 infection was associated with a lower risk of hospitalization (HR, 0.52; 95% CI, 0.38-0.70). Over 2 years of follow-up, there were 1739 cancer treatment disruptions, of which 881 (50.7%) were attributed to COVID-19, with most disruptions occurring within the first 30 days.
The results of this prospective cohort study showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.
回顾性病例系列研究已将患癌症和接受癌症治疗确定为COVID-19预后较差的风险因素。
确定COVID-19感染癌症患者住院和死亡的风险因素。
设计、背景和参与者：国家癌症研究所癌症患者COVID-19研究（NCCAPS）是一项前瞻性纵向自然史队列研究，旨在研究COVID-19对癌症患者的影响。如果成年人在首次SARS-CoV-2检测结果呈阳性后的14天内正在接受癌症积极治疗，或曾接受过干细胞/骨髓移植或CAR T细胞治疗，则符合入选条件。统计分析于2024年9月至2025年4月进行。
该研究的主要目的是确定与COVID-19严重程度相关的患者因素、治疗类型和癌症类型，COVID-19严重程度定义为首次SARS-CoV-2检测结果呈阳性后的30天和90天内因COVID-19住院或死亡。对COVID-19特异性住院和死亡率进行多变量回归分析（比例风险模型和特定病因风险模型）。
在1572名符合条件的成年患者中（年龄中位数[范围]为60[18 - 93]岁；840名女性[53.4%]），1066名（67.8%）患有实体瘤，其中683名（64.0%）患有转移性疾病；乳腺癌（252名[23.6%]）和肺癌（148名[13.9%]）最为常见。在入组时，1013名患者（64.4%）未接种SARS-CoV-2疫苗。90天时COVID-19相关死亡率为3.0%，在后续时间点未增加。淋巴瘤患者在前90天内COVID-19特异性死亡的累积发生率最高，急性白血病和肺癌患者次之，其他实体瘤和其他血液系统癌症患者最低。在多变量分析中，接受化疗（风险比[HR]，1.97；95%置信区间，1.52 - 2.54）以及中风、心房颤动或肺栓塞的基线病史（HR，1.78；95%置信区间，1.33 - 2.38）与住院风险较高相关。SARS-CoV-2感染前接种疫苗与住院风险较低相关（HR，0.52；95%置信区间，0.38 - 0.70）。在超过2年的随访中，有1739次癌症治疗中断，其中881次（50.7%）归因于COVID-19，大多数中断发生在最初30天内。
这项前瞻性队列研究的结果表明，COVID-19对癌症患者有重大影响，包括住院、治疗中断和死亡。
