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Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study - 03/08/20

Doi : 10.1016/S1470-2045(20)30310-7 
Kunyu Yang, ProfMD a, †, Yuhan Sheng, MD a, †, Chaolin Huang, ProfMD f, †, Yang Jin, ProfMD b, †, Nian Xiong, MD c, g, †, Ke Jiang, MD d, †, Hongda Lu, ProfMD h, †, Jing Liu, MD i, Jiyuan Yang, ProfMD j, Youhong Dong, MD k, Dongfeng Pan, MD l, Chengrong Shu, MD m, Jun Li, MD n, Jielin Wei, MD a, Yu Huang, MD a, Ling Peng, MD a, Mengjiao Wu, MD a, Ruiguang Zhang, PhD a, Bian Wu, MD a, Yuhui Li, MD h, Liqiong Cai, MD e, Guiling Li, ProfMD a, Tao Zhang, ProfMD a, Gang Wu, ProfMD a, ⁎
a Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
b Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
c Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
d Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
e Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
f Jin Yin-tan Hospital, Wuhan, China 
g Wuhan Red Cross Hospital, Wuhan, China 
h Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 
i Department of Oncology, Huanggang Central Hospital, Huanggang, China 
j Department of Oncology, The First People’s Hospital Affiliated to Yangtze University, Jingzhou, China 
k Department of Oncology, Xiangyang No.1 People’s Hospital Affiliated to Hubei University of Medicine, Xiangyang, China 
l Department of Oncology, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China 
m Cancer Center, Xianning Central Hospital, the First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China 
n Department of Oncology, The Central Hospital of Xiaogan, Xiaogan, China 

* Correspondence to: Prof Gang Wu, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China Cancer Center Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
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Summary

Background

Patients with cancer are a high-risk population in the COVID-19 pandemic. We aimed to describe clinical characteristics and outcomes of patients with cancer and COVID-19, and examined risk factors for mortality in this population.

Methods

We did a retrospective, multicentre, cohort study of 205 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and with a pathological diagnosis of a malignant tumour in nine hospitals within Hubei, China, from Jan 13 to March 18, 2020. All patients were either discharged from hospitals or had died by April 20, 2020. Clinical characteristics, laboratory data, and cancer histories were compared between survivors and non-survivors by use of χ2 test. Risk factors for mortality were identified by univariable and multivariable logistic regression models.

Findings

Between Jan 13 and Mar 18, 2020, 205 patients with cancer and laboratory-confirmed SARS-CoV-2 infection were enrolled (median age 63 years [IQR 56–70; range 14–96]; 109 [53%] women). 183 (89%) had solid tumours and 22 (11%) had haematological malignancies. The median duration of follow-up was 68 days (IQR 59–78). The most common solid tumour types were breast (40 [20%] patients), colorectal (28 [14%]), and lung cancer (24 [12%]). 54 (30%) of 182 patients received antitumour therapies within 4 weeks before symptom onset. 30 (15%) of 205 patients were transferred to an intensive care unit and 40 (20%) died during hospital admission. Patients with haematological malignancies had poorer prognoses than did those with solid tumours: nine (41%) of 22 patients with haematological malignancies died versus 31 (17%) of 183 patients with solid tumours (hazard ratio for death 3·28 [95% CI 1·56–6·91]; log rank p=0·0009). Multivariable regression analysis showed that receiving chemotherapy within 4 weeks before symptom onset (odds ratio [OR] 3·51 [95% CI 1·16–10·59]; p=0·026) and male sex (OR 3·86 [95% CI 1·57–9·50]; p=0·0033) were risk factors for death during admission to hospital.

Interpretation

Patients with cancer and COVID-19 who were admitted to hospital had a high case-fatality rate. Unfavourable prognostic factors, including receiving chemotherapy within 4 weeks before symptom onset and male sex, might help clinicians to identify patients at high risk of fatal outcomes.

Funding

National Natural Science Foundation of China.

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Vol 21 - N° 7

P. 904-913 - juillet 2020 Retour au numéro
Article précédent Article précédent
  • Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study
  • Jianbo Tian, Xianglin Yuan, Jun Xiao, Qiang Zhong, Chunguang Yang, Bo Liu, Yimin Cai, Zequn Lu, Jing Wang, Yanan Wang, Shuanglin Liu, Biao Cheng, Jin Wang, Ming Zhang, Lu Wang, Siyuan Niu, Zhi Yao, Xiongbo Deng, Fan Zhou, Wei Wei, Qinglin Li, Xin Chen, Wenqiong Chen, Qin Yang, Shiji Wu, Jiquan Fan, Bo Shu, Zhiquan Hu, Shaogang Wang, Xiang-Ping Yang, Wenhua Liu, Xiaoping Miao, Zhihua Wang
| Article suivant Article suivant
  • COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study
  • Marina Chiara Garassino, Jennifer G Whisenant, Li-Ching Huang, Annalisa Trama, Valter Torri, Francesco Agustoni, Javier Baena, Giuseppe Banna, Rossana Berardi, Anna Cecilia Bettini, Emilio Bria, Matteo Brighenti, Jacques Cadranel, Alessandro De Toma, Claudio Chini, Alessio Cortellini, Enriqueta Felip, Giovanna Finocchiaro, Pilar Garrido, Carlo Genova, Raffaele Giusti, Vanesa Gregorc, Francesco Grossi, Federica Grosso, Salvatore Intagliata, Nicla La Verde, Stephen V Liu, Julien Mazieres, Edoardo Mercadante, Olivier Michielin, Gabriele Minuti, Denis Moro-Sibilot, Giulia Pasello, Antonio Passaro, Vieri Scotti, Piergiorgio Solli, Elisa Stroppa, Marcello Tiseo, Giuseppe Viscardi, Luca Voltolini, Yi-Long Wu, Silvia Zai, Vera Pancaldi, Anne-Marie Dingemans, Jan Van Meerbeeck, Fabrice Barlesi, Heather Wakelee, Solange Peters, Leora Horn, TERAVOLT investigators

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