美国范德比尔特大学医学中心Jeremy L Warner团队分析了COVID-19对癌症患者的临床影响。2020年5月28日，《柳叶刀》杂志在线发表了这一成果。

关于COVID-19癌症患者的数据很缺乏。为此，研究组分析了一组同时患有癌症和COVID-19患者的结局，并确定了死亡和重症的潜在预后因素。

在这项队列研究中，研究组使用COVID-19和癌症协会（CCC19）数据库，该数据库在2020年3月17日至4月16日添加了基线数据，收集来自美国、加拿大和西班牙确诊SARS-CoV-2感染且同时患有活动性或此前恶性肿瘤的成年患者的数据，包括基线临床状况、药物、癌症诊断和治疗以及COVID-19病程。主要终点是确诊COVID-19后30天内的全因死亡率。

研究组共纳入928名符合标准的患者，中位年龄为66岁，其中30%超过75岁，男性占50%。最普遍的恶性肿瘤是乳腺癌（191例，21%）和前列腺癌（152例，16%）。366名（39%）患者接受了积极的抗癌治疗，而396名（43％）患者为活动性（可度量的）肿瘤。截至2020年5月7日，共有121名（13％）患者死亡。

在logistic回归分析中，与部分校正后30天死亡率增加相关的独立因素是：年龄增加、男性、吸烟、两个以上合并症、东方肿瘤合作组织绩效状况评分2分及以上、活动性癌症进展和接受阿奇霉素+羟氯喹治疗。与美国东北部的居民相比，加拿大或美国中西部居民30天全因死亡率显著降低。民族和种族、肥胖状况、癌症类型、抗癌治疗类型以及近期手术史均与死亡率不相关。

总之，患有癌症和COVID-19的患者30天全因死亡率很高，且与一般危险因素和癌症患者特有的危险因素呈显著正相关。

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