Outcomes of novel coronavirus disease 2019 (COVID-19) infection in 107 patients with cancer from Wuhan, China
Outcomes of novel coronavirus disease 2019 (COVID-19) infection in 107 patients with cancer from Wuhan, China
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作者：
Zhang, Hongyan;Wang, Linwei;Yu, Yi
癌症患者比非癌症患者患2019冠状病毒病（COVID-19）的风险更高。作者开展了一项多中心回顾性研究，探讨了诊断为COVID-19的癌症患者的临床表现和结局。方法查阅武汉市5家医院2020年1月5日至3月18日住院患者的病历资料。收集与癌症病史（类型、治疗）和COVID-19相关的临床参数。主要终点是总生存期（OS）。次要分析临床因素与重症COVID-19和OS之间的关联。结果本组共107例肿瘤患者被诊断为COVID-19，中位年龄66岁（范围37 ~ 98岁）。肺癌（21例，19.6%）、胃肠道（20例，18.7%）和泌尿生殖系统（20例，18.7%）是最常见的癌症诊断。共有37例患者（34.6%）在诊断为COVID-19时接受了积极的抗癌治疗，而70例患者（65.4%）接受了随访。总体而言，52.3%的患者（56例）发展为重症COVID-19；在接受抗癌治疗的患者中，这一比率高于接受随访的患者（64.9% vs 45.7%），这对应于前一亚组患者的低OS（风险比，3.365;95% CI, 1.455-7.782 [P = 0.005]）。发现抗癌治疗对OS的有害影响与接受全身治疗无关（病死率为33.3%（全身治疗）vs 43.8%（非全身治疗））。结论本研究结果显示，50.0%的癌症感染患者易感重症COVID-19。同时进行抗癌治疗会加剧这种风险，尽管对COVID-19进行了治疗，但这种风险预示着更糟糕的生存。
Background Patients with cancer have a higher risk of coronavirus disease 2019 (COVID-19) than noncancer patients. The authors conducted a multicenter retrospective study to investigate the clinical manifestations and outcomes of patients with cancer who are diagnosed with COVID-19. Methods The authors reviewed the medical records of hospitalized patients who were treated at 5 hospitals in Wuhan City, China, between January 5 and March 18, 2020. Clinical parameters relating to cancer history (type and treatment) and COVID-19 were collected. The primary outcome was overall survival (OS). Secondary analyses were the association between clinical factors and severe COVID-19 and OS. Results A total of 107 patients with cancer were diagnosed with COVID-19, with a median age of 66 years (range, 37-98 years). Lung (21 patients; 19.6%), gastrointestinal (20 patients; 18.7%), and genitourinary (20 patients; 18.7%) cancers were the most common cancer diagnoses. A total of 37 patients (34.6%) were receiving active anticancer treatment when diagnosed with COVID-19, whereas 70 patients (65.4%) were on follow-up. Overall, 52.3% of patients (56 patients) developed severe COVID-19; this rate was found to be higher among patients receiving anticancer treatment than those on follow-up (64.9% vs 45.7%), which corresponded to an inferior OS in the former subgroup of patients (hazard ratio, 3.365; 95% CI, 1.455-7.782 [P = .005]). The detrimental effect of anticancer treatment on OS was found to be independent of exposure to systemic therapy (case fatality rate of 33.3% [systemic therapy] vs 43.8% [nonsystemic therapy]). Conclusions The results of the current study demonstrated that >50.0% of infected patients with cancer are susceptible to severe COVID-19. This risk is aggravated by simultaneous anticancer treatment and portends for a worse survival, despite treatment for COVID-19.