COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study.,The Lancet

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COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study.
The Lancet ( IF 168.9 ) Pub Date : 2020-05-28 , DOI: 10.1016/s0140-6736(20)31173-9
Lennard Yw Lee ₁ , Jean-Baptiste Cazier ₂ , Vasileios Angelis ₃ , Roland Arnold ₄ , Vartika Bisht ₅ , Naomi A Campton ₆ , Julia Chackathayil ₇ , Vinton Wt Cheng ₈ , Helen M Curley ₄ , Matthew W Fittall ₃ , Luke Freeman-Mills ₉ , Spyridon Gennatas ₃ , Anshita Goel ₄ , Simon Hartley ₁₀ , Daniel J Hughes ₁₁ , David Kerr ₁₂ , Alvin Jx Lee ₁₃ , Rebecca J Lee ₁₄ , Sophie E McGrath ₃ , Christopher P Middleton ₁₅ , Nirupa Murugaesu ₁₆ , Thomas Newsom-Davis ₁₇ , Alicia Fc Okines ₃ , Anna C Olsson-Brown ₁₈ , Claire Palles ₄ , Yi Pan ₁₅ , Ruth Pettengell ₁₉ , Thomas Powles ₂₀ , Emily A Protheroe ₂₁ , Karin Purshouse ₂₂ , Archana Sharma-Oates ₂₃ , Shivan Sivakumar ₂₄ , Ashley J Smith ₂₅ , Thomas Starkey ₄ , Chris D Turnbull ₂₆ , Csilla Várnai ₁₅ , Nadia Yousaf ₃ , , Rachel Kerr ₂₄ , Gary Middleton ₂₇

Affiliation

Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK.
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK.
The Royal Marsden Hospital NHS Foundation Trust, London, UK.
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
Centre for Computational Biology, University of Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK.
Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK.
Cancer Research Clinical Research Facility, St George's University Hospitals NHS Foundation Trust, London, UK.
Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
Glasgow Royal Infirmary, Glasgow, UK.
Centre for Computational Biology, University of Birmingham, Birmingham, UK; Advanced Research Computing, University of Birmingham, Birmingham, UK.
Department of Cancer Imaging, King's College London, London, UK.
Nuffield Division of Clinical and Laboratory Services, Oxford University, Oxford, UK.
UCL Cancer Institute, University College London, London, UK.
University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK.
St George's University Hospitals NHS Foundation Trust, London, UK.
Department of Oncology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
The Clatterbridge Cancer Centre, Wirral, UK.
St George's University of London, London, UK.
Bart's Cancer Institute, London, UK.
University of Birmingham Medical School, University of Birmingham, Birmingham, UK.
Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Department of Oncology, Oxford University, Oxford, UK.
Consultancy Support, Oxford, UK.
Nuffield Department of Medicine, Oxford University, Oxford, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK.

Background

Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer.

Methods

In this prospective observational study, all patients with active cancer and presenting to our network of cancer centres were eligible for enrolment into the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effects of COVID-19 on patients with cancer. Eligible patients tested positive for severe acute respiratory syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded patients with a radiological or clinical diagnosis of COVID-19, without a positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge from hospital, as assessed by the reporting sites during the patient hospital admission.

Findings

From March 18, to April 26, 2020, we analysed 800 patients with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a mild COVID-19 disease course. 226 (28%) patients died and risk of death was significantly associated with advancing patient age (odds ratio 9·42 [95% CI 6·56–10·02]; p<0·0001), being male (1·67 [1·19–2·34]; p=0·003), and the presence of other comorbidities such as hypertension (1·95 [1·36–2·80]; p<0·001) and cardiovascular disease (2·32 [1·47–3·64]). 281 (35%) patients had received cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1·18 [0·81–1·72]; p=0·380). We found no significant effect on mortality for patients with immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the past 4 weeks.

Interpretation

Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment.

Funding

University of Birmingham, University of Oxford.

中文翻译：

接受化疗或其他抗癌治疗的癌症患者的 COVID-19 死亡率：一项前瞻性队列研究。

背景

据推测，癌症患者，特别是正在接受全身抗癌治疗的患者，死于 COVID-19 的风险会增加。这一猜想对癌症患者的治疗有相当大的影响，并且由于大流行的突发性，支持这一假设的大型多中心研究的数据很少。我们的目的是描述癌症患者的临床和人口特征以及 COVID-19 结局。

方法

在这项前瞻性观察性研究中，所有患有活动性癌症并就诊于我们癌症中心网络的患者都有资格参加英国冠状病毒癌症监测项目 (UKCCMP)。UKCCMP 是第一个 COVID-19 临床登记处，能够向一线医生提供近乎实时的报告，说明 COVID-19 对癌症患者的影响。符合条件的患者通过鼻或咽喉拭子进行 RT-PCR 检测，检测出严重急性呼吸综合征冠状病毒 2 呈阳性。我们排除了放射学或临床诊断为 COVID-19、且 RT-PCR 检测未呈阳性的患者。主要终点是全因死亡率或出院率，由报告机构在患者入院期间评估。

发现

从 2020 年 3 月 18 日到 4 月 26 日，我们分析了 800 名被诊断为癌症且有症状的 COVID-19 患者。412 名 (52%) 患者患有轻度 COVID-19 病程。226 名 (28%) 患者死亡，死亡风险与患者年龄增长显着相关（比值比 9·42 [95% CI 6·56–10·02]；p<0·0001），为男性 (1·67 [1·19–2·34]；p=0·003），以及其他合并症的存在，例如高血压（1·95 [1·36–2·80]；p<0·001）和心血管疾病（ 2·32 [1·47–3·64]）。281 名 (35%) 患者在 COVID-19 检测呈阳性之前 4 周内接受过细胞毒性化疗。调整年龄、性别和合并症后，与近期未接受化疗的癌症患者相比，过去 4 周的化疗对 COVID-19 疾病的死亡率没有显着影响 (1·18 [0·81–1 ·72]；p=0·380)。我们发现过去 4 周内接受免疫治疗、激素治疗、靶向治疗、放射治疗的患者的死亡率没有显着影响。