Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China
Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China
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COVID-19感染的癌症患者的临床特征：中国武汉市三家医院的回顾性病例研究
DOI：
10.1016/j.annonc.2020.03.296
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发表时间：
2020-07-01
影响因子：
50.5
通讯作者：
Zhou, M.
中科院分区：
文献类型：
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作者：
Zhang, L.;Zhu, F.;Zhou, M.
在当前的2019冠状病毒病（COVID-19）大流行中，癌症患者被视为高度脆弱的群体。迄今为止，感染covid -19的癌症患者的临床特征在很大程度上仍然未知。患者和方法在这项回顾性队列研究中，我们纳入了来自中国武汉三家指定医院的实验室确诊的COVID-19癌症患者。从2020年1月13日至2020年2月26日的医疗记录中收集临床数据。进行单因素和多因素分析以评估与严重事件相关的危险因素，严重事件定义为需要入住重症监护病房、使用机械通气或死亡的情况。结果共纳入28例新型冠状病毒感染的癌症患者；男性17例（60.7%）。年龄中位数（四分位数间距）为65.0（56.0-70.0）岁。肺癌是最常见的癌症类型（n= 7; 25.0%）。8例（28.6%）患者怀疑有医院相关传播。在我们的队列中显示出以下临床特征：发热（n= 23, 82.1%）、干咳（n= 22, 81%）和呼吸困难（n= 14, 50.0%），同时伴有淋巴肿大（n= 23, 82.1%）、高水平的高敏c反应蛋白（n= 23, 82.1%）、贫血（n= 21, 75.0%）和低蛋白血症（n= 25, 89.3%）。常见胸部CT表现为磨玻璃影（n= 21, 75.0%）和斑片状实变（n= 13, 46.3%）。重症事件15例（53.6%），病死率28.6%。如果最后一次抗肿瘤治疗是在14天内，则发生严重事件的风险显著增加[风险比(HR) = 4.079, 95%可信区间（CI） 1.086 ~ 15.322，P= 0.037]。此外，入院时CT上的斑块实变与发生严重事件的高风险相关（HR = 5.438, 95% CI 1.498-19.748，P= 0.010）。结论新型冠状病毒感染后癌症患者病情恶化，预后较差。建议接受抗肿瘤治疗的癌症患者积极筛查COVID-19感染，避免免疫抑制治疗或在合并COVID-19感染时减少剂量。
BackgroundCancer patients are regarded as a highly vulnerable group in the current Coronavirus Disease 2019 (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain largely unknown.Patients and methodsIn this retrospective cohort study, we included cancer patients with laboratory-confirmed COVID-19 from three designated hospitals in Wuhan, China. Clinical data were collected from medical records from 13 January 2020 to 26 February 2020. Univariate and multivariate analyses were carried out to assess the risk factors associated with severe events defined as a condition requiring admission to an intensive care unit, the use of mechanical ventilation, or death.ResultsA total of 28 COVID-19-infected cancer patients were included; 17 (60.7%) patients were male. Median (interquartile range) age was 65.0 (56.0–70.0) years. Lung cancer was the most frequent cancer type (n= 7; 25.0%). Eight (28.6%) patients were suspected to have hospital-associated transmission. The following clinical features were shown in our cohort: fever (n= 23, 82.1%), dry cough (n= 22, 81%), and dyspnoea (n= 14, 50.0%), along with lymphopaenia (n= 23, 82.1%), high level of high-sensitivity C-reactive protein (n= 23, 82.1%), anaemia (n= 21, 75.0%), and hypoproteinaemia (n= 25, 89.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n= 21, 75.0%) and patchy consolidation (n= 13, 46.3%). A total of 15 (53.6%) patients had severe events and the mortality rate was 28.6%. If the last antitumour treatment was within 14 days, it significantly increased the risk of developing severe events [hazard ratio (HR) = 4.079, 95% confidence interval (CI) 1.086–15.322,P= 0.037]. Furthermore, patchy consolidation on CT on admission was associated with a higher risk of developing severe events (HR = 5.438, 95% CI 1.498–19.748,P= 0.010).ConclusionsCancer patients show deteriorating conditions and poor outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 coinfection.