COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study
COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study
复制标题
DOI：
10.1016/s1470-2045(20)30314-4
复制
发表时间：
2020-07-01
期刊：
影响因子：
51.1
通讯作者：
Horn, Leora
中科院分区：
文献类型：
--
作者：
Garassino, Marina Chiara;Whisenant, Jennifer G.;Horn, Leora
背景关于癌症和新冠肺炎患者的早期报告表明，与普通人群相比，癌症患者的死亡率很高。除了癌症治疗外，胸部恶性肿瘤患者被认为特别容易感染新冠肺炎，因为他们的年龄、吸烟习惯和既往存在的心肺合并症。目的研究严重急性呼吸综合征冠状病毒2型感染对胸部恶性肿瘤患者的影响。方法胸科肿瘤国际新冠肺炎合作登记是一项由横断面部分和纵向队列部分组成的多中心观察性研究。资格标准为存在任何胸部癌症(非小细胞肺癌、小细胞肺癌、间皮瘤、胸腺上皮肿瘤和其他肺神经内分泌肿瘤)和新冠肺炎诊断病例，或者经实验室RT-PCR证实，疑似有症状和接触者，或放射学疑似病例的肺部成像特征与新冠肺炎肺炎和症状一致。任何年龄、性别、组织学或分期的患者都被认为是合格的，包括那些正在积极治疗和临床随访的患者。临床数据提取自2020年1月1日以来连续患者的医疗记录，并将一直收集到世卫组织宣布的大流行结束。收集了有关人口统计学、肿瘤史和合并症、新冠肺炎诊断、病程和临床结果的数据。将性别、年龄、吸烟状况、高血压和慢性阻塞性肺疾病纳入多变量分析，通过单变量和多变量Logistic回归，用95%的顺应性的优势比(ORs)来衡量人口统计学或临床特征与预后之间的关系。这是对前200名患者的初步分析。该登记处继续接受新的站点和患者数据。在2020年3月26日至4月12日期间，来自8个国家的200名新冠肺炎和胸癌患者被确定并纳入TERAVOLT登记处；中位年龄为68.0岁(61.8-75.0)，大多数患者的东方合作肿瘤学小组评分为0-1(142例[72%])，现任或曾经吸烟者(159例[81%])，患有非小细胞肺癌(151例[76%])，以及在新冠肺炎确诊时正在接受治疗(147例[74%])，197例患者中有112例(57%)在一线治疗。152例(76%)患者入院治疗，66例(33%)死亡。在134名符合ICU入院标准的患者中，有13人(10%)进入了ICU；其余121人已住院，但没有进入ICU。单因素分析显示，年龄大于65岁(OR 1.88，95%1.00-3.62)、现在或以前吸烟(4.24，1.70-12.95)、单独接受化疗(2.54，1.09-6.41)、合并其他疾病(2.65，1.09-7.46)与死亡风险增加相关。然而，在多变量分析中，只有吸烟史(OR 3.18，95%可信区间1.11-9.06)与死亡风险增加相关。对持续的全球新冠肺炎大流行的解读，我们的数据表明胸癌患者的高死亡率和低重症监护入院率。能否通过重症监护治疗降低死亡率仍有待确定。随着癌症治疗方案的改进，应在基于癌症特定死亡率和患者偏好的多学科环境中讨论获得重症监护的机会。版权所有(C)2020爱思唯尔有限公司。保留所有权利。
Background Early reports on patients with cancer and COVID-19 have suggested a high mortality rate compared with the general population. Patients with thoracic malignancies are thought to be particularly susceptible to COVID-19 given their older age, smoking habits, and pre-existing cardiopulmonary comorbidities, in addition to cancer treatments. We aimed to study the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on patients with thoracic malignancies.Methods The Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry is a multicentre observational study composed of a cross-sectional component and a longitudinal cohort component. Eligibility criteria were the presence of any thoracic cancer (non-small-cell lung cancer [NSCLC], small-cell lung cancer, mesothelioma, thymic epithelial tumours, and other pulmonary neuroendocrine neoplasms) and a COVID-19 diagnosis, either laboratory confirmed with RT-PCR, suspected with symptoms and contacts, or radiologically suspected cases with lung imaging features consistent with COVID-19 pneumonia and symptoms. Patients of any age, sex, histology, or stage were considered eligible, including those in active treatment and clinical follow-up. Clinical data were extracted from medical records of consecutive patients from Jan 1,2020, and will be collected until the end of pandemic declared by WHO. Data on demographics, oncological history and comorbidities, COVID-19 diagnosis, and course of illness and clinical outcomes were collected. Associations between demographic or clinical characteristics and outcomes were measured with odds ratios (ORs) with 95% CIs using univariable and multivariable logistic regression, with sex, age, smoking status, hypertension, and chronic obstructive pulmonary disease included in multivariable analysis. This is a preliminary analysis of the first 200 patients. The registry continues to accept new sites and patient data.Findings Between March 26 and April 12,2020,200 patients with COVID-19 and thoracic cancers from eight countries were identified and included in the TERAVOLT registry; median age was 68.0 years (61.8-75.0) and the majority had an Eastern Cooperative Oncology Group performance status of 0-1 (142 [72%] of 196 patients), were current or former smokers (159 [81%] of 196), had non-small-cell lung cancer (151 [76%] of 200), and were on therapy at the time of COVID-19 diagnosis (147 [74%] of 199), with 112 (57%) of 197 on first-line treatment. 152 (76%) patients were hospitalised and 66 (33%) died. 13 (10%) of 134 patients who met criteria for ICU admission were admitted to ICU; the remaining 121 were hospitalised, but were not admitted to ICU. Univariable analyses revealed that being older than 65 years (OR 1.88, 95% 1.00-3.62), being a current or former smoker (4.24, 1.70-12.95), receiving treatment with chemotherapy alone (2.54, 1.09-6 41), and the presence of any comorbidities (2.65, 1.09-7.46) were associated with increased risk of death. However, in multivariable analysis, only smoking history (OR 3.18, 95% CI 1.11-9.06) was associated with increased risk of death.Interpretation With an ongoing global pandemic of COVID-19, our data suggest high mortality and low admission to intensive care in patients with thoracic cancer. Whether mortality could be reduced with treatment in intensive care remains to be determined. With improved cancer therapeutic options, access to intensive care should be discussed in a multidisciplinary setting based on cancer specific mortality and patients' preference. Copyright (C) 2020 Elsevier Ltd. All rights reserved.