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Multicenter Study
. 2021 Jul 10;39(20):2232-2246.
doi: 10.1200/JCO.21.01074. Epub 2021 Jun 4.

Outcomes of COVID-19 in Patients With Cancer: Report From the National COVID Cohort Collaborative (N3C)

Affiliations
Multicenter Study

Outcomes of COVID-19 in Patients With Cancer: Report From the National COVID Cohort Collaborative (N3C)

Noha Sharafeldin et al. J Clin Oncol. .

Abstract

Purpose: Variation in risk of adverse clinical outcomes in patients with cancer and COVID-19 has been reported from relatively small cohorts. The NCATS' National COVID Cohort Collaborative (N3C) is a centralized data resource representing the largest multicenter cohort of COVID-19 cases and controls nationwide. We aimed to construct and characterize the cancer cohort within N3C and identify risk factors for all-cause mortality from COVID-19.

Methods: We used 4,382,085 patients from 50 US medical centers to construct a cohort of patients with cancer. We restricted analyses to adults ≥ 18 years old with a COVID-19-positive or COVID-19-negative diagnosis between January 1, 2020, and March 25, 2021. We followed N3C selection of an index encounter per patient for analyses. All analyses were performed in the N3C Data Enclave Palantir platform.

Results: A total of 398,579 adult patients with cancer were identified from the N3C cohort; 63,413 (15.9%) were COVID-19-positive. Most common represented cancers were skin (13.8%), breast (13.7%), prostate (10.6%), hematologic (10.5%), and GI cancers (10%). COVID-19 positivity was significantly associated with increased risk of all-cause mortality (hazard ratio, 1.20; 95% CI, 1.15 to 1.24). Among COVID-19-positive patients, age ≥ 65 years, male gender, Southern or Western US residence, an adjusted Charlson Comorbidity Index score ≥ 4, hematologic malignancy, multitumor sites, and recent cytotoxic therapy were associated with increased risk of all-cause mortality. Patients who received recent immunotherapies or targeted therapies did not have higher risk of overall mortality.

Conclusion: Using N3C, we assembled the largest nationally representative cohort of patients with cancer and COVID-19 to date. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Full characterization of the cohort will provide further insights into the effects of COVID-19 on cancer outcomes and the ability to continue specific cancer treatments.

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Conflict of interest statement

Benjamin BatesStock and Other Ownership Interests: Pfizer Eileen LeeEmployment: Johnson & Johnson/Janssen Yu Raymond ShaoEmployment: GlaxoSmithKline, Suzhou Kintor Pharmaceuticals Feifan LiuStock and Other Ownership Interests: Pfizer Timothy BergquistResearch Funding: Celgene Justin GuinneyConsulting or Advisory Role: AstraZenecaResearch Funding: AstraZeneca, Bristol Meyers Squib, Roche/Genentech Umit TopalogluStock and Other Ownership Interests: CareDirectionsNo other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Flow diagram for study cohort. N3C, National COVID Cohort Collaborative.
FIG 2.
FIG 2.
Survival probability curves for COVID-19–positive and COVID-19–negative patients.
FIG 3.
FIG 3.
Survival probability curve by cancer type for COVID-19–positive patients.
FIG 4.
FIG 4.
Adjusted HRs Cox proportional hazard model for association of potential risk factors with 1-year all-cause mortality in (A) entire cohort, and (B) COVID-19–positive patients only. CCI, Charlson Comorbidity Index; HR, hazard ratio; ref, reference. aP < .001. bP < .05.
FIG A1.
FIG A1.
Primary cancer type mapping process. Dx, diagnosis; ICD, International Classification of Diseases.
FIG A2.
FIG A2.
Primary cancer type identification process. Dx, diagnosis; ICD, International Classification of Diseases.
FIG A3.
FIG A3.
Survival probability curves by cancer type and age for COVID-19–positive patients. (A) Skin cancers, (B) breast cancer, (C) prostate cancer, (D) hematologic cancers, (E) GI cancers, and (F) multisite tumors.

Comment in

References

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