COVID-19 in cancer patients: clinical characteristics and outcome—an analysis of the LEOSS registry
Tóm tắt
Since the early SARS-CoV-2 pandemic, cancer patients have been assumed to be at higher risk for severe COVID-19. Here, we present an analysis of cancer patients from the LEOSS (Lean European Open Survey on SARS-CoV-2 Infected Patients) registry to determine whether cancer patients are at higher risk.
We retrospectively analyzed a cohort of 435 cancer patients and 2636 non-cancer patients with confirmed SARS-CoV-2 infection, enrolled between March 16 and August 31, 2020. Data on socio-demographics, comorbidities, cancer-related features and infection course were collected. Age-, sex- and comorbidity-adjusted analysis was performed. Primary endpoint was COVID-19-related mortality.
In total, 435 cancer patients were included in our analysis. Commonest age category was 76–85 years (36.5%), and 40.5% were female. Solid tumors were seen in 59% and lymphoma and leukemia in 17.5% and 11% of patients. Of these, 54% had an active malignancy, and 22% had recently received anti-cancer treatments. At detection of SARS-CoV-2, the majority (62.5%) presented with mild symptoms. Progression to severe COVID-19 was seen in 55% and ICU admission in 27.5%. COVID-19-related mortality rate was 22.5%. Male sex, advanced age, and active malignancy were associated with higher death rates. Comparing cancer and non-cancer patients, age distribution and comorbidity differed significantly, as did mortality (14% vs 22.5%,
Comparing cancer and non-cancer patients, outcome of COVID-19 was comparable after adjusting for age, sex, and comorbidity. However, our results emphasize that cancer patients as a group are at higher risk due to advanced age and pre-existing conditions.
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Tài liệu tham khảo
Rothan HA, Byrareddy SN (2020) The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 109:102433
European Centre for Disease Prevention and Control, E (2020) [cited 2020 04.10.2020]; Available from: https://www.ecdc.europa.eu/en/covid-19-pandemic)
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323(11):1061–1069
Yang X, Yu Y, Xu J, Shu H, Xia J', Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 8(5):475–481
Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, Zhang Z, You H, Wu M, Zheng Q, Xiong Y, Xiong H, Wang C, Chen C, Xiong F, Zhang Y, Peng Y, Ge S, Zhen B, Yu T, Wang L, Wang H, Liu Y, Chen Y, Mei J, Gao X, Li Z, Gan L, He C, Li Z, Shi Y, Qi Y, Yang J, Tenen DG, Chai L, Mucci LA, Santillana M, Cai H (2020) Patients with cancer appear more vulnerable to SARS-CoV-2: a multicenter study during the COVID-19 outbreak. Cancer Discov 10(6):783–791
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, Liu XQ, Chen RC, Tang CL, Wang T, Ou CQ, Li L, Chen PY, Sang L, Wang W, Li JF, Li CC, Ou LM, Cheng B, Xiong S, Ni ZY, Xiang J, Hu Y, Liu L, Shan H, Lei CL, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Cheng LL, Ye F, Li SY, Zheng JP, Zhang NF, Zhong NS, He JX; China Medical Treatment Expert Group for COVID-19 (2020) Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 55(5):2000547
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, Li C, Ai Q, Lu W, Liang H, Li S, He J (2020) Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 21(3):335–337
He W, Chen L, Chen L, Yuan G, Fang Y, Chen W, Wu D, Liang B, Lu X, Ma Y, Li L, Wang H, Chen Z, Li Q, Gale RP (2020) COVID-19 in persons with haematological cancers. Leukemia 34(6):1637–1645
Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, Shete S, Hsu CY, Desai A, de Lima Lopes G Jr, Grivas P, Painter CA, Peters S, Thompson MA, Bakouny Z, Batist G, Bekaii-Saab T, Bilen MA, Bouganim N, Larroya MB, Castellano D, del Prete SA, Doroshow DB, Egan PC, Elkrief A, Farmakiotis D, Flora D, Galsky MD, Glover MJ, Griffiths EA, Gulati AP, Gupta S, Hafez N, Halfdanarson TR, Hawley JE, Hsu E, Kasi A, Khaki AR, Lemmon CA, Lewis C, Logan B, Masters T, McKay RR, Mesa RA, Morgans AK, Mulcahy MF, Panagiotou OA, Peddi P, Pennell NA, Reynolds K, Rosen LR, Rosovsky R, Salazar M, Schmidt A, Shah SA, Shaya JA, Steinharter J, Stockerl-Goldstein KE, Subbiah S, Vinh DC, Wehbe FH, Weissmann LB, Wu JTY, Wulff-Burchfield E, Xie Z, Yeh A, Yu PP, Zhou AY, Zubiri L, Mishra S, Lyman GH, Rini BI, Warner JL, Abidi M, Acoba JD, Agarwal N, Ahmad S, Ajmera A, Altman J, Angevine AH, Azad N, Bar MH, Bardia A, Barnholtz-Sloan J, Barrow B, Bashir B, Belenkaya R, Berg S, Bernicker EH, Bestvina C, Bishnoi R, Boland G, Bonnen M, Bouchard G, Bowles DW, Busser F, Cabal A, Caimi P, Carducci T, Casulo C, Chen JL, Clement JM, Chism D, Cook E, Curran C, Daher A, Dailey M, Dahiya S, Deeken J, Demetri GD, DiLullo S, Duma N, Elias R, Faller B, Fecher LA, Feldman LE, Friese CR, Fu P, Fu J, Futreal A, Gainor J, Garcia J, Gill DM, Gillaspie EA, Giordano A, Glace (M)G, Grothey A, Gulati S, Gurley M, Halmos B, Herbst R, Hershman D, Hoskins K, Jain RK, Jabbour S, Jha A, Johnson DB, Joshi M, Kelleher K, Kharofa J, Khan H, Knoble J, Koshkin VS, Kulkarni AA, Lammers PE, Leighton JC Jr, Lewis MA, Li X, Li A, Lo KMS, Loaiza-Bonilla A, LoRusso P, Low CA, Lustberg MB, Mahadevan D, Mansoor AH, Marcum M, Markham MJ, Handy Marshall C, Mashru SH, Matar S, McNair C, McWeeney S, Mehnert JM, Menendez A, Menon H, Messmer M, Monahan R, Mushtaq S, Nagaraj G, Nagle S, Naidoo J, Nakayama JM, Narayan V, Nelson HH, Nemecek ER, Nguyen R, Nuzzo PV, Oberstein PE, Olszewski AJ, Owenby S, Pasquinelli MM, Philip J, Prabhakaran S, Puc M, Ramirez A, Rathmann J, Revankar SG, Rho YS, Rhodes TD, Rice RL, Riely GJ, Riess J, Rink C, Robilotti EV, Rosenstein L, Routy B, Rovito MA, Saif MW, Sanyal A, Schapira L, Schwartz C, Serrano O, Shah M, Shah C, Shaw G, Shergill A, Shouse G, Soares HP, Solorzano CC, Srivastava PK, Stauffer K, Stover DG, Stratton J, Stratton C, Subbiah V, Tamimi R, Tannir NM, Topaloglu U, van Allen E, van Loon S, Vega-Luna K, Venepalli N, Verma AK, Vikas P, Wall S, Weinstein PL, Weiss M, Wise-Draper T, Wood WA, Xu W(V), Yackzan S, Zacks R, Zhang T, Zimmer AJ, West J (2020) Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet 395(10241):1907–1918
Park R, Chidharla A, Mehta K, Sun W, Wulff-Burchfield E, Kasi A (2020) Sex-bias in COVID-19-associated illness severity and mortality in cancer patients: a systematic review and meta-analysis. EClinicalMedicine 26:100519
Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, Hosein Z, Padda I, Mangat J, Altaf M (2020) Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med 2(30):1–8
Lee LY, Cazier JB, Angelis V, Arnold R, Bisht V, Campton NA, Chackathayil J, Cheng VW, Curley HM, Fittall MW, Freeman-Mills L, Gennatas S, Goel A, Hartley S, Hughes DJ, Kerr D, Lee AJ, Lee RJ, McGrath S, Middleton CP, Murugaesu N, Newsom-Davis T, Okines AF, Olsson-Brown AC, Palles C, Pan Y, Pettengell R, Powles T, Protheroe EA, Purshouse K, Sharma-Oates A, Sivakumar S, Smith AJ, Starkey T, Turnbull CD, Várnai C, Yousaf N, UK Coronavirus Monitoring Project Team, Kerr R, Middleton G (2020) COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet 395(10241):1919–1926
Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, Pradhan K, Thota R, Reissman S, Sparano JA, Gartrell BA, Smith RV, Ohri N, Garg M, Racine AD, Kalnicki S, Perez-Soler R, Halmos B, Verma A (2020) Case fatality rate of cancer patients with COVID-19 in a New York Hospital System. Cancer Discov 10(7):935–941
Shoumariyeh K, Biavasco F, Ihorst G, Rieg S, Nieters A, Kern WV, Miething C, Duyster J, Engelhardt M, Bertz H (2020) Covid-19 in patients with hematological and solid cancers at a Comprehensive Cancer Center in Germany. Cancer Med. https://doi.org/10.1002/cam4.3460
Joharatnam-Hogan N, Khan K (2020) COVID-19 cancer conundrum-evidence driving decisions or the lack of it? BMC Med 18(1):182
Vehreschild JJ, Stecher M, Schons M (2020) [cited 2020 04.10.2020]; Available from: https://leoss.net
Zhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, Jia P, Guan HQ, Peng L, Chen Y, Peng P, Zhang P, Chu Q, Shen Q, Wang Y, Xu SY, Zhao JP, Zhou M (2020) Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol 31(7):894–901
Engelhardt M, Shoumariyeh K, Rösner A, Ihorst G, Biavasco F, Meckel K, von Metzler I, Theurich S, Hebart H, Grube M, Kull M, Bassermann F, Schäfer-Eckart K, Hoferer A, Einsele H, Rasche L, Wäsch R (2020) Clinical characteristics and outcome of multiple myeloma patients with concomitant COVID-19 at Comprehensive Cancer Centers in Germany. Haematologica. https://doi.org/10.3324/haematol.2020.262758
Lee LYW, Cazier JB, Starkey T, Briggs SEW, Arnold R, Bisht V, Booth S, Campton NA, Cheng VWT, Collins G, Curley HM, Earwaker P, Fittall MW, Gennatas S, Goel A, Hartley S, Hughes DJ, Kerr D, Lee AJX, Lee RJ, Lee SM, Mckenzie H, Middleton CP, Murugaesu N, Newsom-Davis T, Olsson-Brown AC, Palles C, Powles T, Protheroe EA, Purshouse K, Sharma-Oates A, Sivakumar S, Smith AJ, Topping O, Turnbull CD, Várnai C, Briggs ADM, Middleton G, Kerr R; UK Coronavirus Cancer Monitoring Project Team (2020) COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol 21(10):1309–1316
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, and the Northwell COVID-19 Research Consortium, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP (2020) Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 323:2052–2059
Jakob CEM, Borgmann S, Duygu F, Behrends U, Hower M, Merle U, Friedrichs A, Tometten L, Hanses F, Jung N, Rieg S, Wille K, Grüner B, Klinker H, Gersbacher-Runge N, Hellwig K, Eberwein L, Dolff S, Rauschning D, von Bergwelt-Baildon M, Lanznaster J, Strauß R, Trauth J, de With K, Ruethrich M, Lueck C, Nattermann J, Tscharntke L, Pilgram L, Fuhrmann S, Classen A, Stecher M, Schons M, Spinner C, Vehreschild JJ (2020) First results of the “Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS)”. Infection. https://doi.org/10.1007/s15010-020-01499-0
Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP (2012) The variability of critical care bed numbers in Europe. Intensive Care Med 38(10):1647–1653
Tian J, Yuan X, Xiao J, Zhong Q, Yang C, Liu B, Cai Y, Lu Z, Wang J, Wang Y, Liu S, Cheng B, Wang J, Zhang M, Wang L, Niu S, Yao Z, Deng X, Zhou F, Wei W, Li Q, Chen X, Chen W, Yang Q, Wu S, Fan J, Shu B, Hu Z, Wang S, Yang XP, Liu W, Miao X, Wang Z (2020) Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncol 21(7):893–903
de Azambuja E, Brandão M, Wildiers H, Laenen A, Aspeslagh S, Fontaine C, Collignon J, Lybaert W, Verheezen J, Rutten A, Vuylsteke P, Goeminne JC, Demey W, van Beckhoven D, Deblonde J, Rottey S, Geukens T, Punie K, Belgian Collaborative Group on COVID-19 Hospital Surveillance and the Belgian Society of Medical Oncology (BSMO) (2020) Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis. ESMO Open 5(5):e000947