英国伯明翰大学Lennard Y W Lee团队分析了化疗或其他抗癌治疗对COVID-19死亡率的影响。相关论文于2020年5月28日发表在《柳叶刀》杂志上。

癌症患者，尤其是正在接受全身性抗癌治疗的患者，罹患COVID-19后死亡风险有可能增加。这一推测对癌症患者的治疗造成很大影响，且由于大流行的突发性，验证该假设的大型多中心研究数据很少。

为了描述癌症患者罹患COVID-19后的临床和人口统计学特征，研究组进行了一项前瞻性观察性研究，招募患有活动性癌症的患者，并对其进行新冠病毒检测。主要终点是全因死亡率和出院情况。

2020年3月18日至2020年4月26日，研究组招募了800例确诊为癌症同时伴有症状性COVID-19的患者。412名（52%）患者患有轻症COVID-19。226名患者（28%）死亡，死亡风险与患者年龄增长、男性、合并高血压、合并心血管疾病等并发症显著相关。281名（35%）患者在COVID-19检测呈阳性之前的4周内接受了细胞毒性化疗。

在校正了年龄、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周内接受化疗对COVID-19死亡率没有显著影响。研究组还发现在过去4周内，使用免疫疗法、激素疗法、靶向疗法和放射疗法对COVID-19死亡率没有显著影响。

总之，癌症患者的COVID-19死亡率似乎主要与年龄、性别和合并症等因素有关。研究组未发现有证据表明接受细胞毒性化疗或其他抗癌治疗增加COVID-19死亡的风险。

附：英文原文

Title: COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study

Author: Lennard Y W Lee, Jean Baptiste Cazier, T Starkey, C D Turnbull, Rachel Kerr, Gary Middleton

Issue&Volume: 2020-05-28

Abstract: 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.

DOI: 10.1016/S0140-6736(20)31173-9

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31173-9/fulltext