Cancer patients diagnosed with COVID-19 infection: a multicenter retrospective cohort of nine Brazilian cancer centers

ABSTRACT

Objectives: The COVID-19 infection was declared pandemic in March 2020. Since then, multiple studies have attempted to correlate clinical factors with the risk of complications from COVID-19. However, cancer patients are underrepresented in clinical trials and the results vary between different cohorts. Our goal is to describe a cohort of cancer patients and COVID-19. Methods: We conducted a multicenter retrospective study, based on a systematic review of medical records, including nine cancer centers, located in five different Brazilian cities. Patients were diagnosed with COVID-19 through RT-PCR between March 15th, 2020, and August 13th, 2020. Poisson regression models were then used to test for an association between clinical characteristics and severity of COVID-19 infections. Results: 102 patients had data collected for analysis, 85 (83.3%) of whom were hospitalized due to complications from COVID-19 infection. The median age was 65.8 years, most were female patients (61.8%) and white (73,5%). 78.4% had a performance status of 0-1, and the most common cancer subtypes were gastrointestinal (30.4%), breast (22.6%), and hematological (13.7%). Almost 40% of the population had stage IV disease. The mortality rate for all hospitalized patients was 36.5%, while that for those admitted to ICU was 68.4%. Key univariable risk factors for mortality included age (RR 1.03), ECOG = 2 (RR 1.83), hypertension (RR 1.72), lung metastasis (RR 1.67), and lymphocytes = 1000 admission (RR 2.40). At the multivariable analysis, the risk factors were also age (RR 1.02), primary lung cancer (RR 2.61), lung metastasis (RR 2.86), and coronary disease (RR 3.76). Conclusions: Despite the high mortality of patients hospitalized with COVID-19, cancer is a heterogeneous disease and some risk factors should be considered as the main responsible for the worst prognosis. Cancer patients should be carefully monitored in pandemic periods of infectious diseases and their management must be individualized.

RESUMO

Objetivos: A infecção pela COVID-19 foi declarada pandêmica em março de 2020. Desde então, vários estudos tentaram correlacionar fatores clínicos com risco de complicações pela COVID-19. No entanto, os pacientes com câncer estão sub-representados nos ensaios clínicos e os resultados variam entre as diferentes coortes. Nosso objetivo é descrever uma coorte de pacientes com câncer e COVID-19. Métodos: Foi realizado um estudo retrospectivo multicêntrico, baseado em revisão sistemática de prontuários médicos, incluindo nove centros oncológicos, localizados em cinco diferentes cidades brasileiras. Os pacientes foram diagnosticados com COVID-19 por RT-PCR entre 15 de março de 2020 e 13 de agosto de 2020. Modelos de regressão de Poisson foram então usados para testar a associação entre as características clínicas e a gravidade das infecções pela COVID-19. Resultados: 102 pacientes tiveram os dados coletados para análise, 85 (83,3%) dos quais foram hospitalizados devido a complicações da infecção pela COVID-19. A mediana de idade foi de 65,8 anos, a maioria era do sexo feminino (61,8%) e da cor branca (73,5%). 78,4% tinham performance status de 0-1, e os subtipos de câncer mais comuns foram gastrointestinal (30,4%), mama (22,6%) e hematológico (13,7%). Quase 40% da população tinha doença em estágio IV. A mortalidade para todos os pacientes internados foi de 36,5%, enquanto a dos internados em UTI foi de 68,4%. Os principais fatores de risco univariados para mortalidade incluíram idade (RR 1,03), ECOG=2 (RR 1,83), hipertensão (RR 1,72), metástase pulmonar (RR 1,67) e na admissão linfócitos =1.000 (RR 2,40). Na análise multivariável, os fatores de risco também foram idade (RR 1,02), câncer primário de pulmão (RR 2,61), metástase pulmonar (RR 2,86) e doença coronariana (RR 3,76). Conclusão: Apesar da alta mortalidade dos pacientes internados com COVID-19, o câncer é uma doença heterogênea e alguns fatores de risco devem ser considerados como os principais responsáveis pelo pior prognóstico. Pacientes com câncer devem ser cuidadosamente monitorados em períodos de pandemia de doenças infecciosas e seu manejo deve ser individualizado.

Keywords:

Coronavirus Infections - SARS Virus - Cancer Symptoms - Risk Factors - Clinical Evolution.

Descritores:

Infecções por Coronavírus - Vírus SARS - Sintomas do câncer - Fatores derisco - Evolução Clínica.

Publikationsverlauf

Eingereicht: 14. Februar 2021

Angenommen: 18. März 2021

Artikel online veröffentlicht:
14. Mai 2021

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