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 ORCID:

Dajing XIA

https://orcid.org/0000-0003-1645-9046

Yihua WU

https://orcid.org/0000-0001-7952-4090

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Journal of Zhejiang University SCIENCE B 2021 Vol.22 No.10 P.876-884

http://doi.org/10.1631/jzus.B2100151


Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis


Author(s):  Haohua LU, Yu SHI, Kelie CHEN, Zhi CHEN, Haihong ZHU, Yuequn NIU, Dajing XIA, Yihua WU

Affiliation(s):  Department of Toxicology of School of Public Health and Department of Gynecologic Oncology of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou310058, China; more

Corresponding email(s):   dxia@zju.edu.cn, georgewu@zju.edu.cn

Key Words:  COVID-19, Cancer, Anti-tumor regimens, Pooled analysis


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Haohua LU, Yu SHI, Kelie CHEN, Zhi CHEN, Haihong ZHU, Yuequn NIU, Dajing XIA, Yihua WU. Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis[J]. Journal of Zhejiang University Science B, 2021, 22(10): 876-884.

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year="2021",
publisher="Zhejiang University Press & Springer",
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A1 - Yihua WU
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Abstract: 
Since the outbreak of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) discovered in December 2019, the disease has emerged as a global pandemic (Shi et al., 2020; World Health Organization, 2020). Several studies have shown a higher incidence of COVID-19, as well as related poor outcomes in patients with malignancies as compared with those without them (Liang et al., 2020; Tian et al., 2020). The impact of cancer on COVID-19 may be attri‑buted to the use of antitumor treatments that may disturb the host response to SARS-CoV-2 infection (Wang et al., 2020), while the current studies on this topic have drawn controversial conclusions. Some implied that anticancer treatments might elevate the risk of death (García-Suárez et al., 2020; Liu et al., 2020). On the contrary, others pointed out that this association is not significant (Brar et al., 2020; Lee et al., 2020a). Although previous systematic reviews have investigated this important issue (Wang and Huang, 2020), the heterogeneity of findings is obvious and the general conclusion has remained unclear. Considering this ambiguity, it is difficult for clinicians to make therapeutic decisions when facing patients with both cancer and COVID-19; therefore, a high-quality and accurate evaluation of the impact of anticancer treatments on COVID-19 patients is necessary. Accordingly, we conducted a pooled analysis with the original data of each patient for the first time to provide a comprehensive perspective into the association between anticancer regimens and the outcomes of cancer patients with COVID-19.

肿瘤治疗方案对肿瘤合并新型冠状病毒肺炎患者临床结局的影响分析

概要:不同的肿瘤治疗方案可能是肿瘤合并新型冠状病毒肺炎(COVID-19)患者预后较差的原因之一,但是目前相关研究却仍未有定论。因此,全面深入的分析可以辅助临床医生选择和制定新型冠状病毒流行期间的抗肿瘤治疗方案。我们通过从PubMed、Embase和Cochrane数据库检索得到的提供了每个患者临床信息的11项相关研究展开汇总分析。本研究发现化疗是这些COVID-19合并肿瘤的患者中最常见的抗肿瘤治疗。经过对混杂因素的调整,抗肿瘤治疗方案对患者结局的影响并不显著。值得关注的是,在对于化疗和激素治疗的研究中,高龄(≥65岁)会增加这类患者发生死亡(化疗的研究中比值比(OR)=2.36,95%的置信区间(95% CI)=1.11~5.01,P=0.025;激素治疗的研究中OR=2.29;95% CI=1.08~4.85,P=0.03)及严重事件(OR=2.72,95% CI=1.45~5.10,P=0.002)的可能性,心脑血管疾病病史则会增加这类患者发生严重事件的可能性(OR=1.91;95% CI=1.02~3.57,P=0.043)。在进一步的亚组分析中,我们发现免疫治疗可能会显著增加患有实体肿瘤的新型冠状病毒患者死亡(OR=2.66,95% CI=1.07~6.64,P=0.03)和发生严重事件(OR=5.04,95% CI=1.02~24.86,P=0.039)的可能性,而化疗则可能显著增加患有血液系统肿瘤的新型冠状病毒患者死亡的可能性(OR=4.11,95% CI=1.59~10.6,P=0.003)。综上所述,在多因素模型中,相较于不同的肿瘤治疗方案,影响肿瘤合并COVID-19患者预后的关键临床因素如年龄、心脑血管病等,可能更为关键。在亚组分析中,免疫治疗和化疗则可能分别对实体肿瘤患者和血液肿瘤患者有较为显著的影响。

关键词:COVID-19;肿瘤治疗方案;化疗,免疫治疗;汇总分析

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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