Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
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DOI：
10.1016/s0140-6736(20)31187-9
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发表时间：
2020-06-20
期刊：
影响因子：
168.9
通讯作者：
Warner, Jeremy L.
中科院分区：
文献类型：
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作者：
Kuderer, Nicole M.;Choueiri, Toni K.;Warner, Jeremy L.
缺乏关于COVID-19癌症患者的背景数据。在这项队列研究中，我们收集了年龄在18岁及以上、确诊为严重急性呼吸综合征冠状病毒2型的活动性或既往恶性肿瘤患者的去识别数据，（SARS-CoV-2）感染来自美国，加拿大和西班牙的COVID-19和癌症联盟（CCC 19）数据库，其基线数据在2020年3月17日至4月16日之间添加。我们收集了基线临床状况、药物、癌症诊断和治疗以及COVID-19病程的数据。主要终点是确诊COVID-19后30天内的全因死亡率。我们使用逻辑回归分析评估了结果与潜在预后变量之间的关联，并根据年龄、性别、吸烟状况和肥胖进行了部分调整。该研究在ClinicalTrials.gov注册，NCT 04354701，并正在进行中。结果在研究期间，1035例记录输入CCC 19数据库，928例患者符合我们分析的纳入标准。中位年龄为66岁（IQR 57-76），279例（30%）患者年龄≥ 75岁，468例（50%）患者为男性。最常见的恶性肿瘤为乳腺癌（191例[21%]）和前列腺癌（152例[16%]）。366例（39%）患者正在接受积极的抗癌治疗，396例（43%）患者患有活动性（可测量）癌症。在分析时（2020年5月7日），121例（13%）患者死亡。在logistic回归分析中，经部分调整后，与30天死亡率增加相关的独立因素为：（每10年;部分校正的比值比1.84，95% CI 1.53-2.21），男性（1.63，1.07-2.48），吸烟状况（既往吸烟者vs从不吸烟者：1.60，1.03-2.47），合并症数量（2 vs无：4.50，1.33-15.28），东部肿瘤协作组体能状态≥ 2（状态2 vs 0或1：3.89，2.11-7.18），活动性癌症（进展vs缓解：5.20，2.77-9.77），并接受阿奇霉素+羟氯喹（vs两种治疗均未使用：2.93，1.79-4.79;不能排除适应症的混淆）。与居住在美国东北部相比，居住在加拿大（0.24，0.07-0.84）或美国中西部（0.50，0.28-0.90）与30天全因死亡率降低相关。在癌症和COVID-19患者中，30天全因死亡率较高，与一般风险因素和癌症患者特有的风险因素相关。需要更长时间的随访，以更好地了解COVID-19对癌症患者结局的影响，包括继续特定癌症治疗的能力。版权所有（C）2020爱思唯尔有限公司保留所有权利。
Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing.Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1.84, 95% CI 1.53-2.21), male sex (1.63, 1.07-2.48), smoking status (former smoker vs never smoked: 1.60, 1.03-2.47), number of comorbidities (two vs none: 4.50, 1.33-15.28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3.89, 2.11-7.18), active cancer (progressing vs remission: 5.20, 2.77-9.77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2.93, 1.79-4.79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0.24, 0.07-0.84) or the US-Midwest (0.50, 0.28-0.90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality.Interpretation Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments. Copyright (C) 2020 Elsevier Ltd. All rights reserved.