COVID-19癌症患者30天全因死亡率較高
作者：
小柯機器人發布時間：2020/5/31 23:45:54
美國範德比爾特大學醫學中心Jeremy L Warner團隊分析了COVID-19對癌症患者的臨床影響。2020年5月28日，《柳葉刀》雜誌在線發表了這一成果。
關於COVID-19癌症患者的數據很缺乏。為此，研究組分析了一組同時患有癌症和COVID-19患者的結局，並確定了死亡和重症的潛在預後因素。
在這項隊列研究中，研究組使用COVID-19和癌症協會（CCC19）資料庫，該資料庫在2020年3月17日至4月16日添加了基線數據，收集來自美國、加拿大和西班牙確診SARS-CoV-2感染且同時患有活動性或此前惡性腫瘤的成年患者的數據，包括基線臨床狀況、藥物、癌症診斷和治療以及COVID-19病程。主要終點是確診COVID-19後30天內的全因死亡率。
研究組共納入928名符合標準的患者，中位年齡為66歲，其中30%超過75歲，男性佔50%。最普遍的惡性腫瘤是乳腺癌（191例，21%）和前列腺癌（152例，16%）。366名（39%）患者接受了積極的抗癌治療，而396名（43％）患者為活動性（可度量的）腫瘤。截至2020年5月7日，共有121名（13％）患者死亡。
在logistic回歸分析中，與部分校正後30天死亡率增加相關的獨立因素是：年齡增加、男性、吸菸、兩個以上合併症、東方腫瘤合作組織績效狀況評分2分及以上、活動性癌症進展和接受阿奇黴素+羥氯喹治療。與美國東北部的居民相比，加拿大或美國中西部居民30天全因死亡率顯著降低。民族和種族、肥胖狀況、癌症類型、抗癌治療類型以及近期手術史均與死亡率不相關。
總之，患有癌症和COVID-19的患者30天全因死亡率很高，且與一般危險因素和癌症患者特有的危險因素呈顯著正相關。
附：英文原文
Title: Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
Author: Nicole M Kuderer, Toni K Choueiri, Dimpy P Shah, Yu Shyr, Samuel M Rubinstein, Donna R Rivera, Sanjay Shete, Chih-Yuan Hsu, Aakash Desai, Gilberto de Lima Lopes, Petros Grivas, Corrie A Painter, Solange Peters, Michael A Thompson, Ziad Bakouny, Gerald Batist, Tanios Bekaii-Saab, Mehmet A Bilen, Nathaniel Bouganim, Mateo Bover Larroya, Daniel Castellano, Salvatore A Del Prete, Deborah B Doroshow, Pamela C Egan, Arielle Elkrief, Dimitrios Farmakiotis, Daniel Flora, Matthew D Galsky, Michael J Glover, Elizabeth A Griffiths, Anthony P Gulati, Shilpa Gupta, Navid Hafez, Thorvardur R Halfdanarson, Jessica E Hawley, Emily Hsu, Anup Kasi, Ali R Khaki, Christopher A Lemmon, Colleen Lewis, Barbara Logan, Tyler Masters, Rana R McKay, Ruben A Mesa, Alicia K Morgans, Mary F Mulcahy, Orestis A Panagiotou, Prakash Peddi, Nathan A Pennell, Kerry Reynolds, Lane R Rosen, Rachel Rosovsky, Mary Salazar, Andrew Schmidt, Sumit A Shah, Justin A Shaya, John Steinharter, Keith E Stockerl-Goldstein, Suki Subbiah, Donald C Vinh, Firas H Wehbe, Lisa B Weissmann, Julie Tsu-Yu Wu, Elizabeth Wulff-Burchfield, Zhuoer Xie, Albert Yeh, Peter P Yu, Alice Y Zhou, Leyre Zubiri, Sanjay Mishra, Gary H Lyman, Brian I Rini, Jeremy L Warner
Issue&Volume: 2020-05-28
Abstract: 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.
DOI: 10.1016/S0140-6736(20)31187-9
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31187-9/fulltext