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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.
Lancet Oncol. 2020 07; 21(7):904-913.LO

Abstract

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.

Authors+Show Affiliations

Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Jin Yin-tan Hospital, Wuhan, China.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.Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Wuhan Red Cross Hospital, Wuhan, China.Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Oncology, Huanggang Central Hospital, Huanggang, China.Department of Oncology, The First People's Hospital Affiliated to Yangtze University, Jingzhou, China.Department of Oncology, Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine, Xiangyang, China.Department of Oncology, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China.Cancer Center, Xianning Central Hospital, the First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China.Department of Oncology, The Central Hospital of Xiaogan, Xiaogan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: xhzlwg@163.com.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32479787

Citation

Yang, Kunyu, 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." The Lancet. Oncology, vol. 21, no. 7, 2020, pp. 904-913.
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. 2020;21(7):904-913.
Yang, K., Sheng, Y., Huang, C., Jin, Y., Xiong, N., Jiang, K., Lu, H., Liu, J., Yang, J., Dong, Y., Pan, D., Shu, C., Li, J., Wei, J., Huang, Y., Peng, L., Wu, M., Zhang, R., Wu, B., ... Wu, G. (2020). Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. The Lancet. Oncology, 21(7), 904-913. https://doi.org/10.1016/S1470-2045(20)30310-7
Yang K, 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. 2020;21(7):904-913. PubMed PMID: 32479787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. AU - Yang,Kunyu, AU - Sheng,Yuhan, AU - Huang,Chaolin, AU - Jin,Yang, AU - Xiong,Nian, AU - Jiang,Ke, AU - Lu,Hongda, AU - Liu,Jing, AU - Yang,Jiyuan, AU - Dong,Youhong, AU - Pan,Dongfeng, AU - Shu,Chengrong, AU - Li,Jun, AU - Wei,Jielin, AU - Huang,Yu, AU - Peng,Ling, AU - Wu,Mengjiao, AU - Zhang,Ruiguang, AU - Wu,Bian, AU - Li,Yuhui, AU - Cai,Liqiong, AU - Li,Guiling, AU - Zhang,Tao, AU - Wu,Gang, Y1 - 2020/05/29/ PY - 2020/04/07/received PY - 2020/05/05/revised PY - 2020/05/06/accepted PY - 2020/6/2/pubmed PY - 2020/7/18/medline PY - 2020/6/2/entrez SP - 904 EP - 913 JF - The Lancet. Oncology JO - Lancet Oncol VL - 21 IS - 7 N2 - 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. SN - 1474-5488 UR - https://www.unboundmedicine.com/medline/citation/32479787/Clinical_characteristics_outcomes_and_risk_factors_for_mortality_in_patients_with_cancer_and_COVID_19_in_Hubei_China:_a_multicentre_retrospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1470-2045(20)30310-7 DB - PRIME DP - Unbound Medicine ER -