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Clinical Characteristics and Risk Factors for COVID-19 Severity and Mortality Among Cancer Patients in Wuhan and Hubei

Findings from two Chinese multicentre, retrospective, cohort studies
10 Jun 2020
Cancer in Special Situations / Population

A study on COVID-19 disease severity in patients with cancer in Wuhan, China provides detailed clinical and laboratory information and highlights that risk factors, including elevated TNF-α and NT-proBNP and decreased CD4+ T cells or albumin–globulin ratio would be helpful for early surveillance of disease progression, in addition to previously reported risk factors of older age, elevated IL-6, procalcitonin, D-dimer, and decreased lymphocytes. A second report on clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China found that patients with cancer and COVID-19 who were admitted to hospital had a high case-fatality rate. Receiving chemotherapy 4 weeks before symptom onset and male sex are two indicators that might help clinicians to identify patients with cancer who are at high risk of fatal outcomes at an early stage. Findings from both studies are published on 29 May in The Lancet Oncology.

First study was a multicentre, retrospective, cohort study in all adult patients with any type of solid tumours and haematological malignancies admitted to 9 hospitals in Wuhan. They had laboratory-confirmed COVID-19 and were admitted between 13 January and 18 March 2020. These patients were matched (2:1) with COVID-19 patients without cancer admitted to hospital with propensity score on the basis of age, sex, and comorbidities. COVID-19 disease severity was defined on admission based on WHO guidelines.

During the study period, 13077 patients with COVID-19 were admitted to hospital; of those 232 patients with cancer and 519 statistically matched patients without cancer. Median follow-up was 29 days in patients with cancer and 27 days in patients without cancer.

Patients with cancer were more likely to have severe COVID-19 disease than patients without cancer (64% vs 32%), odds ratio (OR) 3.61 (95% confidence interval [CI] 2.59–5.04; p < 0.0001).

Risk factors previously reported in patients without cancer, such as older age, elevated IL-6, procalcitonin, D-dimer, and reduced lymphocytes were validated in patients with cancer.

The study team also identified advanced tumour stage with OR 2.60 (95% CI 1.05–6.43; p = 0.039), elevated TNF-α with OR 1.22 (1.01–1.47; p = 0.037), elevated NT-proBNP with OR 1.65 (1.03–2.78; p = 0.032), reduced CD4+ T cells with OR 0.84 (0.71–0.98; p = 0.031), and reduced albumin–globulin ratio with OR 0.12 (0.02–0.77; p = 0.024) as risk factors of COVID-19 severity in cancer patients.

The authors concluded that these indices are helpful for assessing disease severity and should be extensively monitored during COVID-19 treatment in case of adverse status. Greater attention should be given to cancer patients with COVID-19, as findings suggest they are more likely to deteriorate into severe illness according study authors.

Second study was a retrospective, multicentre, cohort study of 205 cancer patients with laboratory-confirmed severe COVID-19 admitted to nine hospitals in Hubei, China from 13 January to 18 March 2020. All patients were either discharged or died by 20 April 2020. Clinical characteristics, laboratory data, and cancer history were compared between survivors and non-survivors.

Median age was 63 years (range 14 to 96); 109 patients (53%) were women. In total, 183 patients (89%) had solid tumours and 22 patients (11%) had haematological malignancies. Most common solid tumours were breast cancer (20%), colorectal cancer (14%), and lung cancer (12%).

Median duration of follow-up was 68 days. In total, 54 of 182 patients (30%) received antitumour therapy within 4 weeks before symptom onset.

In total, 30 of 205 patients (15%) were transferred to an intensive care unit and 40 patients (20%) died during hospital admission.

Patients with haematological malignancies had poorer prognoses than those with solid tumours. In particular, 9 of 22 patients (41%) with haematological malignancies died versus 31 of 183 patients (17%) with solid tumours, hazard ratio for death 3.28 (95% CI 1.56–6.91; log rank p = 0.0009).

Severe pneumonia occurred in 52 patients (25%) and in-hospital case-fatality rate in cancer patients with COVID-19 was 20%, which is much higher than the case-fatality rate for COVID-19 in the overall Chinese population reported previously as 1%.

Multivariable regression analysis showed that receiving chemotherapy within 4 weeks before symptom onset with OR 3.51 (95% CI 1.16–10.59; p = 0.026) and male sex with OR 3.86 (95% CI 1.57–9.50; p = 0.0033) were risk factors for death during admission to hospital.

The authors concluded that patients with haematological malignancies had poorer prognoses than those with solid tumours. Receiving chemotherapy within 4 weeks before symptom onset, and male sex were risk factors for in-hospital mortality. 

References

Tian J, Yuan X, Xiao J, et al. 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; Published online 29 May 2020. DOI: https://doi.org/10.1016/S1470-2045(20)30309-0. 

Yang K, Sheng Y, Huang C, et al. Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol; Published online 29 May 2020. DOI: https://doi.org/10.1016/S1470-2045(20)30310-7.

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