Chemotherapy and COVID-19 Outcomes in Patients With Cancer
Chemotherapy and COVID-19 Outcomes in Patients With Cancer
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DOI：
10.1200/jco.20.01307
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发表时间：
2020-10-20
影响因子：
45.3
通讯作者：
Pessin, Melissa S.
中科院分区：
文献类型：
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作者：
Jee, Justin;Foote, Michael B.;Pessin, Melissa S.
© 2019 www. secoronavirus.保留所有权利癌症患者的COVID-19死亡率高于一般人群，但COVID-19不良结局的癌症相关风险因素尚未完全表征。患者和方法我们回顾了2020年3月31日之前在纪念斯隆-凯特琳癌症中心（Memorial Sloan Kettering Cancer Center）接受COVID-19治疗的癌症患者的临床特征和结局（n = 309），并观察临床终点，直至2020年4月13日。我们假设，在COVID-19诊断后35天内给予细胞毒性化疗与重度或危重COVID-19的风险比（HR）增加相关。在二次分析中，我们估计了特定临床和实验室变量与严重或危重COVID-19事件发生率之间的相关性。使用MTT细胞毒性化疗与严重或危重COVID-19事件无显著相关性（HR，1.10; 95%CI，0.73至1.60）。血液系统恶性肿瘤与COVID-19严重程度增加相关（HR，1.90; 95% CI，1.30至2.80）。肺癌患者的重度或危重COVID-19事件发生率也较高（HR，2.0; 95% CI，1.20至3.30）。COVID-19诊断时淋巴细胞减少症与重度或危重疾病的发生率较高相关（HR，2.10; 95%CI，1.50至3.10）。在COVID-19诊断前14-90天基线中性粒细胞减少的患者结局更差（HR，4.20; 95%CI，1.70 - 11.00）。这些分析的结果在多变量模型和多重敏感性分析中保持一致。在时间匹配的非COVID-19癌症患者人群中，不良事件发生率较低。结论近期细胞毒性化疗治疗与COVID-19不良结局无关。患有活动性血液或肺部恶性肿瘤、围COVID-19淋巴细胞减少症或基线中性粒细胞减少症的患者的COVID-19结局更差。化疗、癌症类型和COVID-19之间的相互作用很复杂，需要进一步研究。
PURPOSECoronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized.PATIENTS AND METHODSWe reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event.RESULTSCytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19.CONCLUSIONRecent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri-COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.