Differences in Outcomes and Factors Associated With Mortality Among Patients With SARS-CoV-2 Infection and Cancer Compared With Those Without Cancer: A Systematic Review and Meta-analysis.
Differences in Outcomes and Factors Associated With Mortality Among Patients With SARS-CoV-2 Infection and Cancer Compared With Those Without Cancer: A Systematic Review and Meta-analysis.
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DOI：
10.1001/jamanetworkopen.2022.10880
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发表时间：
2022-05-02
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
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作者：
这项系统性综述和荟萃分析了年龄、性别、癌症类型和治疗与癌症和COVID-19诊断患者生存率的关系。同时患有癌症和SARS-CoV-2感染的患者的临床结局如何？在这项涉及61532名癌症患者的81项研究的系统性综述和荟萃分析中，年龄较小、患有肺癌或血液癌的患者因COVID-19死亡的风险增加。在抗癌治疗中，化疗与最高的死亡风险相关，内分泌治疗与最低的风险相关。这项研究的结果表明，年轻的癌症患者是COVID-19预后不良的高风险人群。SARS-CoV-2感染与癌症患者更严重的疾病和死亡有关。然而，某些肿瘤类型、治疗方法以及癌症患者的年龄和性别对COVID-19结果的影响仍不清楚。评估SARS-CoV-2感染的癌症患者与非癌症但感染SARS-CoV-2的患者之间临床结局的差异，并确定预后不良风险特别高的癌症患者。检索PubMed、Web of Science和Scopus数据库中截至2021年6月14日以英文发表的文章。对这些文章中的参考文献进行了审查，以进行其他研究。纳入了所有病例对照或队列研究，这些研究涉及10名或10名以上患有恶性疾病和SARS-CoV-2感染的患者，有或没有对照组（定义为没有癌症但患有SARS-CoV-2感染的患者）。如果研究涉及的患者少于10例，是会议论文或摘要，是预印本报告，没有全文，或无法从通讯作者处获得数据，则将其排除。两名研究者使用系统性综述和荟萃分析（PRISMA）报告指南的首选报告项目独立进行数据提取。采用随机效应模型进行荟萃分析。癌症和SARS-CoV-2感染患者与对照患者之间死亡率的差异，以及各种肿瘤类型和癌症治疗结果的差异。采用了合并病例死亡率、随机效应模型和随机效应荟萃回归分析。共纳入81项研究，涉及61532例癌症患者。在58849例有可用数据的患者中，纳入了30557例男性（52%），中位年龄范围为35 - 74岁。当年龄和性别匹配时，患有癌症与没有癌症的患者之间COVID-19死亡的相对风险（RR）为1.69（95%CI，1.46-1.95; P <0.001; I2 = 51.0%）。癌症患者与对照组患者的死亡率RR与年龄降低相关（exp [B]，0.96; 95% CI，0.92-0.99; P = 0.03）。与其他癌症相比，肺癌（RR，1.68; 95%CI，1.45-1.94; P <0.001; I2 = 32.9%）和血液系统癌症（RR，1.42; 95%CI，1.31-1.54; P <0.001; I2 = 6.8%）与更高的死亡风险相关。虽然发现泌尿生殖系统癌的点估计值较高（RR，1.11; 95% CI，1.00-1.24; P = 0.06; I2 = 21.5%），但该发现无统计学显著性。乳腺癌（RR，0.51; 95%CI，0.36-0.71; P <0.001; I2 = 86.2%）和妇科癌症（RR，0.76; 95%CI，0.62-0.93; P = 0.009; I2 = 0%）与较低的死亡风险相关。化疗与30%的最高总病死率相关（95%CI，25%-36%; I2 = 86.97%;范围，10%-100%），内分泌治疗与11%的最低病死率相关（95%CI，6%-16%; I2 = 70.68%;范围，0%-27%）。这项研究的结果表明，患有癌症和SARS-CoV-2感染的患者比没有癌症的患者有更高的死亡风险。年轻、肺癌和血液癌也是与COVID-19预后不良相关的风险因素。
This systematic review and meta-analysis analyzed the association of age, sex, and cancer types and therapies with survival rates among patients with both cancer and COVID-19 diagnosis. What are the clinical outcomes for patients with both cancer and SARS-CoV-2 infection? In this systematic review and meta-analysis of 81 studies involving 61 532 patients with cancer, patients who were younger, had lung cancer, or had hematologic cancer were at an increased risk of mortality from COVID-19. Among anticancer treatments, chemotherapy was associated with the highest mortality risk and endocrine therapy was associated with the lowest risk. Findings of this study suggest that younger patients with cancer are a high-risk population for poor outcomes from COVID-19. SARS-CoV-2 infection has been associated with more severe disease and death in patients with cancer. However, the implications of certain tumor types, treatments, and the age and sex of patients with cancer for the outcomes of COVID-19 remain unclear. To assess the differences in clinical outcomes between patients with cancer and SARS-CoV-2 infection and patients without cancer but with SARS-CoV-2 infection, and to identify patients with cancer at particularly high risk for a poor outcome. PubMed, Web of Science, and Scopus databases were searched for articles published in English until June 14, 2021. References in these articles were reviewed for additional studies. All case-control or cohort studies were included that involved 10 or more patients with malignant disease and SARS-CoV-2 infection with or without a control group (defined as patients without cancer but with SARS-CoV-2 infection). Studies were excluded if they involved fewer than 10 patients, were conference papers or abstracts, were preprint reports, had no full text, or had data that could not be obtained from the corresponding author. Two investigators independently performed data extraction using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Meta-analysis was performed using a random-effects model. The difference in mortality between patients with cancer and SARS-CoV-2 infection and control patients as well as the difference in outcomes for various tumor types and cancer treatments. Pooled case fatality rates, a random-effects model, and random-effects meta-regressions were used. A total of 81 studies were included, involving 61 532 patients with cancer. Among 58 849 patients with available data, 30 557 male individuals (52%) were included and median age ranged from 35 to 74 years. The relative risk (RR) of mortality from COVID-19 among patients with vs without cancer when age and sex were matched was 1.69 (95% CI, 1.46-1.95; P < .001; I2 = 51.0%). The RR of mortality in patients with cancer vs control patients was associated with decreasing age (exp [b], 0.96; 95% CI, 0.92-0.99; P = .03). Compared with other cancers, lung cancer (RR, 1.68; 95% CI, 1.45-1.94; P < .001; I2 = 32.9%), and hematologic cancer (RR, 1.42; 95% CI, 1.31-1.54; P < .001; I2 = 6.8%) were associated with a higher risk of death. Although a higher point estimate was found for genitourinary cancer (RR, 1.11; 95% CI, 1.00-1.24; P = .06; I2 = 21.5%), the finding was not statistically significant. Breast cancer (RR, 0.51; 95% CI, 0.36-0.71; P < .001; I2 = 86.2%) and gynecological cancer (RR, 0.76; 95% CI, 0.62-0.93; P = .009; I2 = 0%) were associated with a lower risk of death. Chemotherapy was associated with the highest overall pooled case fatality rate of 30% (95% CI, 25%-36%; I2 = 86.97%; range, 10%-100%), and endocrine therapy was associated with the lowest at 11% (95% CI, 6%-16%; I2 = 70.68%; range, 0%-27%). Results of this study suggest that patients with cancer and SARS-CoV-2 infection had a higher risk of death than patients without cancer. Younger age, lung cancer, and hematologic cancer were also risk factors associated with poor outcomes from COVID-19.
影响因子：
50.5
作者：
Palmieri C;Turtle L;Drake T;Harrison E;Docherty A;Greenhalf B;Openshaw P;Baillie JK;Semple MM
通讯作者：
Semple MM