Pacientes com câncer são vulneráveis ao COVID-19, com uma maior letalidade em comparação a população em geral. Em especial, os pacientes do sexo masculino com câncer e que receberam quimioterapia dentro de 4 semanas antes do início dos sintomas do COVID-19 podem precisar de atenção médica e cuidados de suporte adicionais pelo maior risco de mortalidade hospitalar.
O artigo foi publicado na revista The Lancet pelo pesquisador Chinês Yang e colaboradores.
De modo geral, os pacientes com neoplasias hematológicas tiveram pior prognóstico do que aqueles com tumores sólidos. Foi observado que nove (41%) dos 22 pacientes com neoplasias hematológicas morreram contra 31 (17%) dos 183 pacientes com tumores sólidos. Ainda foi identificado que o uso de quimioterapia dentro de 4 semanas antes do início dos sintomas e ser do sexo masculino foram os principais fatores de risco para morte durante a internação no hospital.
A idade avançada não foi considerado fator de risco pelo fato da maioria dos participantes acometidos pelo câncer serem idosos (mediana de idade de 63 anos).
O tipo de estudo foi coorte retrospectivo, multicêntrico. Participaram do estudo 205 pacientes com infecção pelo coronavírus 2 por síndrome respiratória aguda grave confirmada em laboratório (SARS-CoV-2) e com diagnóstico patológico de tumor maligno em nove hospitais de Hubei, China, a partir de 13 de janeiro até 18 de março de 2020. Todos os pacientes tiveram alta hospitalar ou morreram até 20 de abril de 2020.
O link para leitura do artigo:
https://www.thelancet.com/journals/lancet/article/PIIS1470-2045(20)30310-7/fulltext#%20
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; S1470-2045(20)30310-7.
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.
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