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. 2021 Aug;125(3):358-365.
doi: 10.1038/s41416-021-01396-9. Epub 2021 May 11.

Impact of active cancer on COVID-19 survival: a matched-analysis on 557 consecutive patients at an Academic Hospital in Lombardy, Italy

Alexia F Bertuzzi #  1 , Michele Ciccarelli #  2 , Andrea Marrari  1 , Nicolò Gennaro  3   4 , Andrea Dipasquale  3   5 , Laura Giordano  6 , Umberto Cariboni  7 , Vittorio Lorenzo Quagliuolo  8 , Marco Alloisio  3   7 , Armando Santoro  9   10
Affiliations

Impact of active cancer on COVID-19 survival: a matched-analysis on 557 consecutive patients at an Academic Hospital in Lombardy, Italy

Alexia F Bertuzzi et al. Br J Cancer. 2021 Aug.

Abstract

Background: The impact of active cancer in COVID-19 patients is poorly defined; however, most studies showed a poorer outcome in cancer patients compared to the general population.

Methods: We analysed clinical data from 557 consecutive COVID-19 patients. Uni-multivariable analysis was performed to identify prognostic factors of COVID-19 survival; propensity score matching was used to estimate the impact of cancer.

Results: Of 557 consecutive COVID-19 patients, 46 had active cancer (8%). Comorbidities included diabetes (n = 137, 25%), hypertension (n = 284, 51%), coronary artery disease (n = 114, 20%) and dyslipidaemia (n = 122, 22%). Oncologic patients were older (mean age 71 vs 65, p = 0.012), more often smokers (20% vs 8%, p = 0.009), with higher neutrophil-to-lymphocyte ratio (13.3 vs 8.2, p = 0.046). Fatality rate was 50% (CI 95%: 34.9;65.1) in cancer patients and 20.2% (CI 95%: 16.8;23.9) in the non-oncologic population. Multivariable analysis showed active cancer (HRactive: 2.26, p = 0.001), age (HRage>65years: 1.08, p < 0.001), as well as lactate dehydrogenase (HRLDH>248mU/mL: 2.42, p = 0.007), PaO2/FiO2 (HRcontinuous: 1.00, p < 0.001), procalcitonin (HRPCT>0.5ng/mL: 2.21, p < 0.001), coronary artery disease (HRyes: 1.67, p = 0.010), cigarette smoking (HRyes: 1.65, p = 0.041) to be independent statistically significant predictors of outcome. Propensity score matching showed a 1.92× risk of death in active cancer patients compared to non-oncologic patients (p = 0.013), adjusted for ICU-related bias. We observed a median OS of 14 days for cancer patients vs 35 days for other patients.

Conclusion: A near-doubled death rate between cancer and non-cancer COVID-19 patients was reported. Active cancer has a negative impact on clinical outcome regardless of pre-existing clinical comorbidities.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. COVID-19 survival in cancer and non-cancer patients.
Cancer patients showed a poorer COVID-19 survival (HR: 2.26; CI 95%: 1.39;3.66, p = 0.001).
Fig. 2
Fig. 2. COVID-19 survival stratified by subtype of cancer and status of disease.
a solid cancer vs haematologic cancer; b tumour type (lung vs other); c localised vs metastatic disease; d disease status at COVID-19 diagnosis (PD vs non-PD cancer patients).
See this image and copyright information in PMC

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