Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study
Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study
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中国湖北省癌症和 COVID-19 患者的临床特征、结果和死亡危险因素：一项多中心、回顾性队列研究
DOI：
10.1016/s1470-2045(20)30310-7
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发表时间：
2020-07-01
期刊：
影响因子：
51.1
通讯作者：
Wu, Gang
中科院分区：
文献类型：
--
作者：
Yang, Kunyu;Sheng, Yuhan;Wu, Gang
背景癌症患者是COVID-19大流行的高危人群。我们的目的是描述癌症和COVID-19患者的临床特征和结局，并检查该人群死亡的风险因素。方法我们对205例实验室确诊的严重急性呼吸综合征冠状病毒2型患者进行了回顾性、多中心、队列研究（SARS-CoV-2）感染，并于2020年1月13日至3月18日在中国湖北省的九家医院进行了恶性肿瘤的病理诊断。截至2020年4月20日，所有患者均已出院或死亡。通过卡方检验比较存活者和非存活者的临床特征、实验室数据和癌症史。结果2020年1月13日至3月18日期间，205名患有癌症和实验室确诊的SARS-CoV-2感染的患者入组（中位年龄63岁[IQR 56-70;范围14-96]; 109名[53%]女性）。183例（89%）患有实体瘤，22例（11%）患有血液学恶性肿瘤。中位随访时间为68天（IQR 59-78）。最常见的实体瘤类型为乳腺癌（40例[20%]患者）、结直肠癌（28例[14%]）和肺癌（24例[12%]）。182例患者中有54例（30%）在症状发作前4周内接受了抗肿瘤治疗。205名患者中有30名（15%）被转移到重症监护室，40名（20%）在入院期间死亡。血液恶性肿瘤患者的预后比实体瘤患者差：22例血液恶性肿瘤患者中有9例（41%）死亡，而183例实体瘤患者中有31例（17%）死亡（死亡风险比为3.28 [95%CI 1.00]）。56-6 91];对数秩p=0.0009）。多因素回归分析显示，发病前4周内接受化疗（比值比[OR] 3.51 [95% CI 1.16-10.59]; p=0.026）和男性（OR 3.86 [95% CI 1.57-9.50]; p=0.0033）是住院期间死亡的危险因素。解读住院的癌症和COVID-19患者病死率高。不利的预后因素，包括在症状发作前4周内接受化疗和男性，可能有助于临床医生识别具有致死性结局高风险的患者。版权所有（C）2020爱思唯尔有限公司保留所有权利。
Background Patients with cancer are a high-risk population in the COVID-19 pandemic. We aimed to describe clinical characteristics and outcomes of patients with cancer and COVID-19, and examined risk factors for mortality in this population.Methods We did a retrospective, multicentre, cohort study of 205 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and with a pathological diagnosis of a malignant tumour in nine hospitals within Hubei, China, from Jan 13 to March 18, 2020. All patients were either discharged from hospitals or had died by April 20, 2020. Clinical characteristics, laboratory data, and cancer histories were compared between survivors and non-survivors by use of chi(2) test. Risk factors for mortality were identified by univariable and multivariable logistic regression models.Findings Between Jan 13 and Mar 18, 2020, 205 patients with cancer and laboratory-confirmed SARS-CoV-2 infection were enrolled (median age 63 years [IQR 56-70; range 14-96]; 109 [53%] women). 183 (89%) had solid tumours and 22 (11%) had haematological malignancies. The median duration of follow-up was 68 days (IQR 59-78). The most common solid tumour types were breast (40 [20%] patients), colorectal (28 [14%]), and lung cancer (24 [12%]). 54 (30%) of 182 patients received antitumour therapies within 4 weeks before symptom onset. 30 (15%) of 205 patients were transferred to an intensive care unit and 40 (20%) died during hospital admission. Patients with haematological malignancies had poorer prognoses than did those with solid tumours: nine (41%) of 22 patients with haematological malignancies died versus 31 (17%) of 183 patients with solid tumours (hazard ratio for death 3.28 [95% CI 1. 56-6 91]; log rank p=0.0009). Multivariable regression analysis showed that receiving chemotherapy within 4 weeks before symptom onset (odds ratio [OR] 3.51 [95% CI 1.16-10.59]; p=0.026) and male sex (OR 3.86 [95% CI 1.57-9.50]; p=0.0033) were risk factors for death during admission to hospital.Interpretation Patients with cancer and COVID-19 who were admitted to hospital had a high case-fatality rate. Unfavourable prognostic factors, including receiving chemotherapy within 4 weeks before symptom onset and male sex, might help clinicians to identify patients at high risk of fatal outcomes. Copyright (C) 2020 Elsevier Ltd. All rights reserved.