Clinical characteristics and risk factors for mortality in cancer patients with COVID-19

doi:10.1007/s11684-021-0845-6

Frontiers of Medicine

2021, Vol. 15

Issue (2): 264-274 https://doi.org/10.1007/s11684-021-0845-6

本期目录

Clinical characteristics and risk factors for mortality in cancer patients with COVID-19

Junnan Liang¹, Guannan Jin², Tongtong Liu³, Jingyuan Wen¹, Ganxun Li¹, Lin Chen^1,³, Wei Wang¹, Yuwei Wang¹, Wei Liao¹, Jia Song¹, Zeyang Ding^1,³(

), Xiao-ping Chen^1,³(

), Bixiang Zhang^1,³(

)

¹. Hepatic Surgery Center, Liver Cancer Institute, and Hubei Key Laboratory of HPB Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
². Department of Internal Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
³. Tongji Multidisciplinary Team for Treating COVID-19 (TTTC), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

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Abstract：

Patients with cancer are at increased risk of severe infections. From a cohort including 3060 patients with confirmed COVID-19, 109 (3.4%) cancer patients were included in this study. Among them, 23 (21.1%) patients died in the hospital. Cancer patients, especially those with hematological malignancies (41.6%), urinary carcinoma (35.7%), malignancies of the digestive system (33.3%), gynecological malignancies (20%), and lung cancer (14.3%), had a much higher mortality than patients without cancer. A total of 19 (17.4%) cancer patients were infected in the hospital. The clinical characteristics of deceased cancer patients were compared with those of recovered cancer patients. Multivariate Cox regression analysis indicated that a Nutritional Risk Screening (NRS2002) score≥3 (adjusted hazard ratio (HR) 11.00; 95% confidence interval (CI) 4.60–26.32; P <0.001), high-risk type (adjusted HR 18.81; 95% CI 4.21–83.93; P <0.001), tumor stage IV (adjusted HR 4.26; 95% CI 2.34–7.75; P <0.001), and recent adjuvant therapy (<1 month) (adjusted HR 3.16; 95% CI 1.75–5.70; P <0.01) were independent risk factors for in-hospital death after adjusting for age, comorbidities, D-dimer, and lymphocyte count. In conclusion, cancer patients showed a higher risk of COVID-19 infection with a poorer prognosis than patients without cancer. Cancer patients with high-risk tumor, NRS2002 score≥3, advanced tumor stage, and recent adjuvant therapy (<1 month) may have high risk of mortality.

Key words： cancer COVID-19 SARS-CoV-2 risk factor mortality

收稿日期: 2020-08-27 出版日期: 2021-04-23

Corresponding Author(s): Zeyang Ding,Xiao-ping Chen,Bixiang Zhang

引用本文:

. [J]. Frontiers of Medicine, 2021, 15(2): 264-274.
Junnan Liang, Guannan Jin, Tongtong Liu, Jingyuan Wen, Ganxun Li, Lin Chen, Wei Wang, Yuwei Wang, Wei Liao, Jia Song, Zeyang Ding, Xiao-ping Chen, Bixiang Zhang. Clinical characteristics and risk factors for mortality in cancer patients with COVID-19. Front. Med., 2021, 15(2): 264-274.

链接本文:

https://academic.hep.com.cn/fmd/CN/10.1007/s11684-021-0845-6
https://academic.hep.com.cn/fmd/CN/Y2021/V15/I2/264

Variables	All patients (n = 109)	Recovered (n = 86)	Deceased (n = 23)	P value
Age (year, median (IQR))	65.00 (56.00, 71.00)	64.00 (56.00, 70.00)	68.00 (53.50, 76.50)	0.33
Age≥65 years	55 (50.5)	42 (48.8)	13 (56.5)	0.675
Sex
Female	52 (47.7)	43 (50.0)	9 (39.1)	0.489
Male	57 (52.3)	43 (50.0)	14 (60.9)	0.489
Source of infection
Nosocomial transmission*	19 (17.5)	11 (12.8)	8 (34.8)	0.014
Community infection**	90 (82.5)	75 (87.2)	15 (65.2)	0.014
During out-of-hospital treatment	6 (5.5)	2 (2.3)	4 (17.4)	< 0.001
Follow-up period	84 (77.0)	73 (84.9)	11 (47.8)	< 0.001
Signs and symptoms at admission
Fever	86 (78.9)	68 (79.1)	18 (78.3)	1
Cough	75 (68.8)	59 (68.6)	16 (69.6)	1
Expectoration	49 (45.0)	37 (43.0)	12 (52.2)	0.584
Shortness of breath	51 (46.8)	39 (45.3)	12 (52.2)	0.728
Pharyngalgia	5 (4.6)	4 (4.7)	1 (4.3)	1
Rhinorrhoea	3 (2.8)	2 (2.3)	1 (4.3)	1
Fatigue	25 (22.9)	18 (20.9)	7 (30.4)	0.494
Chest pain	8 (7.3)	7 (8.1)	1 (4.3)	0.866
Diarrhea	26 (23.9)	20 (23.3)	6 (26.1)	0.994
Abdominal pain	5 (4.6)	3 (3.5)	2 (8.7)	0.618
Anorexia	26 (23.9)	21 (24.4)	5 (21.7)	1
Nausea or vomiting	10 (9.2)	7 (8.1)	3 (13.0)	0.751
Myalgia	14 (12.8)	11 (12.8)	3 (13.0)	1
Headache	9 (8.3)	7 (8.1)	2 (8.7)	1
Dizziness	8 (7.3)	7 (8.1)	1 (4.3)	0.866
Respiratory rate, breath per minute Pulse, beat per minute Median arterial pressure, mmHg Percutaneous oxygen saturation, %	20.00 (20.00, 22.00) 86.00 (76.00, 98.00) 96.33 (90.67, 103.33) 96.00 (92.00, 99.00)	20.00 (20.00, 22.00) 85.00 (76.00, 97.75) 96.83 (92.17, 103.58) 96.50 (94.25, 99.00)	20.00 (20.00, 22.50) 89.00 (78.00, 105.50) 93.00 (83.83, 101.00) 89.00 (75.00, 97.00)	0.661 0.296 0.127 0.005
Chronic comorbidities
Hypertension	38 (34.9)	33 (38.4)	5 (21.7)	0.215
Diabetes	18 (16.5)	15 (17.4)	3 (13.0)	0.85
Cardiovascular disease	10 (9.2)	9 (10.5)	1 (4.3)	0.62
Cerebrovascular disease	4 (3.7)	4 (4.7)	0 (0.0)	0.668
Chronic pulmonary disease	19 (17.4)	17 (19.8)	2 (8.7)	0.35
Chronic kidney disease	3 (2.8)	3 (3.5)	0 (0.0)	0.849
Chronic liver disease	10 (9.2)	6 (7.0)	4 (17.4)	0.258
Clinical type on admission
Severe pneumonia	60 (55.0)	44 (51.2)	16 (69.6)	0.18
Days from illness onset to outcome	41.28 (29.00, 54.50)	45.50 (33.00, 56.26)	25.52 (15.00, 33.00)	< 0.001
Days from admission to outcome	23.72 (13.24, 36.63)	26.67 (17.51, 41.12)	7.62 (4.44, 17.25)	< 0.001

Tab.1

Variables	All patients (n = 109)	Recovered (n = 86)	Deceased (n = 23)	P value
Tumor type
Lung cancer	14 (12.8)	12 (13.9)	2 (8.2)	0.503
Malignancy of the digestive system	24 (22.0)	16 (18.6)	8 (34.8)	0.096
Gastric carcinoma	8 (7.3)	5 (5.8)	3 (13.0)	0.237
Colorectal cancer	5 (4.6)	4 (4.7)	1 (4.3)	0.949
Esophagus cancer	4 (3.7)	2 (2.3)	2 (8.7)	0.149
Rectal cancer	2 (1.8)	2 (2.3)	0	0.460
Liver cancer	5 (4.6)	3 (3.5)	2 (8.7)	0.289
Head and neck cancer	21 (19.3)	21 (24.4)	0	0.008
Laryngeal carcinoma	1 (0.9)	1 (1.2)	0	0.603
Oral cancer	1 (0.9)	1 (1.2)	0	0.603
Nasopharyngeal carcinoma	3 (2.7)	3 (3.5)	0	0.363
Thyroid cancer	16 (14.7)	16 (18.6)	0	0.025
Hematological malignancies	12 (11.0)	7 (8.1)	5 (21.7)	0.064
Leukemia	7 (6.4)	4 (4.7)	3 (13.0)	0.144
Lymphoma	4 (3.7)	3 (3.5)	1 (4.3)	0.845
Multiple myeloma	1 (0.9)	0	1 (4.3)	0.052
Urinary carcinoma	14 (12.8)	9 (10.5)	5 (21.7)	0.151
Bladder cancer	8 (7.3)	4 (4.7)	4 (17.4)	0.037
Prostate cancer	4 (3.7)	3 (3.5)	1 (4.3)	0.845
Renal carcinoma	2 (1.8)	2 (2.3)	0	0.460
Breast cancer	11 (10.1)	11 (12.8)	0	0.070
Gynecological malignancies	10 (9.2)	8 (9.3)	2 (8.7)	0.928
Uterine malignancy	4 (3.7)	3 (3.5)	1 (4.3)	0.845
Cervical cancer	5 (4.6)	4 (4.7)	1 (4.3)	0.949
Ovarian cancer	1 (0.9)	1 (1.2)	0	0.603
Others	3 (2.7)	2 (2.3)	1 (4.3)	0.312
Spinal tumor	1 (0.9)	1 (1.2)	0	0.598
Bronchial tumor	1 (0.9)	1 (1.2)	0	0.603
Liposarcoma	1 (0.9)	0	1 (4.3)	0.052
Condition grading
Karnofsky performance score (≥70)	8 (7.3)	5 (5.8)	3 (13.0)	0.237
ECOG performance status score (>2)	3 (2.7)	1 (1.2)	2 (8.7)	0.049
NRS2002 score (≥3)	39 (35.7)	19 (22.1)	20 (86.9)	< 0.001
Tumor stage
Stage I/II/III	86 (78.8)	75 (87.2)	11 (47.8)	< 0.001
Stage IV	23 (21.2)	11 (12.3)	12 (52.1)	< 0.001
History of prior treatment
Operation	65 (59.6)	55 (64.0)	10 (43.4)	0.075
a. Operation (<1 month)	4 (3.7)	4 (4.7)	0	0.291
Adjuvant therapy	59 (54.1)	40 (46.5)	19 (82.6)	0.002
Recent adjuvant therapy	20 (18.3)	8 (9.3)	12 (52.1)	< 0.001
Chemo-/radiotherapy	54 (49.5)	38 (44.2)	16 (69.5)	0.031
b. Recent chemo-/radiotherapy (<1 month)	17 (15.6)	7 (8.1)	10 (43.4)	< 0.001
Targeted/immunotherapy	9 (8.2)	4 (4.7)	5 (21.7)	0.008
c. Recent targeted/immunotherapy (<1 month)	3 (2.7)	1 (1.2)	2 (8.7)	0.049

Tab.2

Tab.3

Patient characteristics and findings	Univariate
Patient characteristics and findings	HR (95% CI)	P value
Age, >65 years	1.528 (0.668–3.493)	0.315
Sex, male	1.399 (0.605–3.234)	0.433
Chronic comorbidities
Chronic pulmonary disease	0.396 (0.093–1.689)	0.211
Signs and symptoms at admission
Percutaneous oxygen saturation,≤93%	3.345 (1.473–7.599)	0.004
Tumor type
High-risk type	11.094 (1.495–82.35)	0.019
Tumor stage
Tumor stage IV	6.025 (2.647–13.713)	< 0.001
Condition grading
Karnofsky performance score (≥70)	0.512 (0.152–1.724)	0.28
ECOG performance status score (> 2)	4.95 (1.152–53.191)	0.032
NRS2002 score (≥3)	14.53 (4.31–48.91)	< 0.001
History of prior treatment
Operation	0.566 (0.248–1.292)	0.176
a. Operation (<1 month)	1.304 (0.174–9.757)	0.796
Adjuvant therapy	5.137 (1.743–15.139)	0.003
Recent adjuvant therapy (<1 month)	4.194 (1.845–9.534)	< 0.001
Chemo-/radiotherapy	2.589 (1.064–6.301)	0.036
b. Recent chemo-/radiotherapy (<1 month)	4.834 (2.116–11.043)	< 0.001
Targeted/immunotherapy	3.662 (1.352–9.914)	0.011
c. Recent targeted/immunotherapy (<1 month)	3.458 (0.803–14.898)	0.096
Combined (a+ b or a+ c)	3.786 (0.507–28.29)	0.195
Source of infection
Nosocomial infection	2.501 (1.56–5.923)	0.037
Chest computed tomography scan features
Bilateral	1.071 (0.134–8.568)	0.948
Laboratory findings
Lymphocyte count, <1.1 × 10⁹/L	2.874 (0.976–8.468)	0.055
Platelet count, <125 × 10⁹/L	6.752 (2.859–15.951)	< 0.001
Hemoglobin, <120 g/L	2.006 (0.868–4.638)	0.104
D-dimer, >1 µg/mL	4.018 (1.365–11.828)	0.012
Aspartate aminotransferase, > 40 U/L	2.516 (1.1–5.751)	0.029
Total bilirubin, > 21.1 µmol/L	5.000 (1.96–12.5)	0.001
Direct bilirubin, > 8 µmol/L	2.85 (1.204–6.666)	0.018
Albumin, <35 g/L	3.823 (1.411–10.25)	0.008
Lactose dehydrogenase, >214 U/L	2.394 (0.879–6.521)	0.088
High-sensitivity cardiac troponin I, >15.6 pg/mL	7.081 (2.782–18.026)	< 0.001
N-terminal pro-brain natriuretic peptide, > 486 pg/mL	6.329 (2.409–16.666)	< 0.001
Highly sensitive C-reactive protein, >10 mg/L	10.11 (1.362–75.072)	0.024
Serum ferritin, > 400 µg/L	7.173 (0.942–54.639)	0.057
IL-6, > 62 U/mL	0 (0-Inf)	0.998
Procalcitonin, > 0.05 ng/mL	8.268 (1.105–61.874)	0.04
IL-10, > 9.1 pg/mL	8.242 (2.751–24.7)	< 0.001

Tab.4

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