Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study.,The Lancet

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Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study.
The Lancet ( IF 168.9 ) Pub Date : 2020-05-28 , DOI: 10.1016/s0140-6736(20)31187-9
Nicole M Kuderer ₁ , Toni K Choueiri ₂ , Dimpy P Shah ₃ , Yu Shyr ₄ , Samuel M Rubinstein ₄ , Donna R Rivera ₅ , Sanjay Shete ₆ , Chih-Yuan Hsu ₄ , Aakash Desai ₇ , Gilberto de Lima Lopes ₈ , Petros Grivas ₉ , Corrie A Painter ₁₀ , Solange Peters ₁₁ , Michael A Thompson ₁₂ , Ziad Bakouny ₂ , Gerald Batist ₁₃ , Tanios Bekaii-Saab ₁₄ , Mehmet A Bilen ₁₅ , Nathaniel Bouganim ₁₆ , Mateo Bover Larroya ₁₇ , Daniel Castellano ₁₇ , Salvatore A Del Prete ₁₈ , Deborah B Doroshow ₁₉ , Pamela C Egan ₂₀ , Arielle Elkrief ₁₃ , Dimitrios Farmakiotis ₂₀ , Daniel Flora ₂₁ , Matthew D Galsky ₁₉ , Michael J Glover ₂₂ , Elizabeth A Griffiths ₂₃ , Anthony P Gulati ₁₈ , Shilpa Gupta ₂₄ , Navid Hafez ₂₅ , Thorvardur R Halfdanarson ₂₆ , Jessica E Hawley ₂₇ , Emily Hsu ₂₈ , Anup Kasi ₂₉ , Ali R Khaki ₉ , Christopher A Lemmon ₂₄ , Colleen Lewis ₁₅ , Barbara Logan ₂₁ , Tyler Masters ₂₅ , Rana R McKay ₃₀ , Ruben A Mesa ₃ , Alicia K Morgans ₃₁ , Mary F Mulcahy ₃₁ , Orestis A Panagiotou ₃₂ , Prakash Peddi ₃₃ , Nathan A Pennell ₂₄ , Kerry Reynolds ₃₄ , Lane R Rosen ₃₃ , Rachel Rosovsky ₃₄ , Mary Salazar ₃ , Andrew Schmidt ₂ , Sumit A Shah ₂₂ , Justin A Shaya ₃₀ , John Steinharter ₂ , Keith E Stockerl-Goldstein ₃₅ , Suki Subbiah ₃₆ , Donald C Vinh ₁₆ , Firas H Wehbe ₃₁ , Lisa B Weissmann ₃₇ , Julie Tsu-Yu Wu ₂₂ , Elizabeth Wulff-Burchfield ₂₉ , Zhuoer Xie ₂₆ , Albert Yeh ₉ , Peter P Yu ₃₈ , Alice Y Zhou ₃₅ , Leyre Zubiri ₃₄ , Sanjay Mishra ₄ , Gary H Lyman ₉ , Brian I Rini ₄ , Jeremy L Warner ₄ ,

Affiliation

Advanced Cancer Research Group, Kirkland, WA, USA.
Dana-Farber Cancer Institute, Boston, MA, USA.
Mays Cancer Center, UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA.
Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
MD Anderson Cancer Center, Houston, TX, USA.
University of Connecticut, Farmington, CT, USA.
Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL, USA.
Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
Count Me In, Cambridge, MA, USA.
Lausanne University, Lausanne, Switzerland.
Advocate Aurora Health, Milwaukee, WI, USA.
Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada.
Mayo Clinic Cancer Center, Phoenix, AZ, USA.
Winship Cancer Institute of Emory University, Atlanta, GA, USA.
McGill University Health Centre, Montreal, QC, Canada.
Hospital Universitario 12 de Octubre, Madrid, Spain.
Stamford Hospital, Stamford, CT, USA.
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
The Warren Alpert Medical School of Brown University, Providence, RI, USA.
St. Elizabeth Healthcare, Edgewood, KY, USA.
Stanford University, Stanford, CA, USA.
Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Cleveland Clinic, Cleveland, OH, USA.
Smilow Cancer Hospital at Yale New Haven, New Haven, CT, USA.
Mayo Clinic Cancer Center, Rochester, MN, USA.
Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, USA.
University of Connecticut, Farmington, CT, USA; Hartford Health Care, Hartford, CT, USA.
University of Kansas Medical Center, Kansas City, KS, USA.
Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
School of Public Health, Brown University, Providence, RI, USA.
Willis-Knighton Cancer Center, Shreveport, LA, USA.
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA.
Stanley S Scott Cancer Center, LSU Health, New Orleans, LA, USA.
Mount Auburn Hospital, Cambridge, MA, USA.
Hartford Health Care, Hartford, CT, USA.

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.

Funding

American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

中文翻译：

COVID-19 对癌症患者 (CCC19) 的临床影响：一项队列研究。

背景

缺乏有关患有癌症的 COVID-19 患者的数据。在这里，我们描述了一组患有癌症和 COVID-19 的患者的结果，并确定了死亡率和严重疾病的潜在预后因素。

方法

在这项队列研究中，我们收集了来自美国、加拿大和西班牙的年龄 18 岁及以上、患有活动性或既往恶性肿瘤、确诊严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染的患者的去识别化数据。 COVID-19 和癌症联盟 (CCC19) 数据库在 2020 年 3 月 17 日至 4 月 16 日期间添加了基线数据。我们收集了有关基线临床状况、药物、癌症诊断和治疗以及 COVID-19 病程的数据。主要终点是诊断 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。这项研究已在 ClinicalTrials.gov 注册，NCT04354701，并且正在进行中。

发现

在研究期间输入 CCC19 数据库的 1035 条记录中，有 928 名患者符合我们分析的纳入标准。中位年龄为 66 岁 (IQR 57-76)，279 名 (30%) 患者年龄为 75 岁或以上，468 名 (50%) 患者为男性。最常见的恶性肿瘤是乳腺癌 (191 [21%]) 和前列腺 (152 [16%])。366 名 (39%) 患者正在接受积极的抗癌治疗，其中 396 名 (43%) 患者患有活动性（可测量）癌症。截至分析（2020 年 5 月 7 日），有 121 名患者 (13%) 死亡。在逻辑回归分析中，部分调整后与 30 天死亡率增加相关的独立因素为：年龄增加（每 10 年；部分调整优势比 1·84，95% CI 1·53–2·21）、男性(1·63, 1·07–2·48)，吸烟状况（以前吸烟者与从不吸烟：1·60, 1·03–2·47），合并症数量（两种与无：4·50, 1· 33–15·28)，东部肿瘤合作组表现状态为 2 或更高（2与0 或 1的状态：3·89、2·11–7·18）、活动性癌症（进展与缓解：5·20、 2·77–9·77)，并接受阿奇霉素加羟氯喹治疗（对比两者都不治疗：2·93、1·79–4·79；不能排除适应症造成的混杂）。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) 与居住在 30 天的时间减少有关全因死亡率。种族和民族、肥胖状况、癌症类型、抗癌治疗类型以及近期手术与死亡率无关。