作者
Jie Luo,Hira Rizvi,Isabel R. Preeshagul,Jacklynn V. Egger,David Hoyos,Chai Bandlamudi,Caroline G. McCarthy,Christina J. Falcon,Adam J. Schoenfeld,Kathryn C. Arbour,Jamie E. Chaft,Robert Michael Daly,A. Drilon,Juliana Eng,Afsheen Iqbal,W. Victoria Lai,B.T. Li,Piro Lito,Azadeh Namakydoust,Kim Tien Ng,Michael Offin,Paul K. Paik,Gregory J. Riely,Charles M. Rudin,Helena A. Yu,Marjorie G. Zauderer,Mark T.A. Donoghue,Marta Łuksza,Benjamin Greenbaum,Mark G. Kris,Matthew D. Hellmann
摘要
Background
Patients with lung cancers may have disproportionately severe coronavirus disease 2019 (COVID-19) outcomes. Understanding the patient-specific and cancer-specific features that impact the severity of COVID-19 may inform optimal cancer care during this pandemic. Patients and methods
We examined consecutive patients with lung cancer and confirmed diagnosis of COVID-19 (n = 102) at a single center from 12 March 2020 to 6 May 2020. Thresholds of severity were defined a priori as hospitalization, intensive care unit/intubation/do not intubate ([ICU/intubation/DNI] a composite metric of severe disease), or death. Recovery was defined as >14 days from COVID-19 test and >3 days since symptom resolution. Human leukocyte antigen (HLA) alleles were inferred from MSK-IMPACT (n = 46) and compared with controls with lung cancer and no known non-COVID-19 (n = 5166). Results
COVID-19 was severe in patients with lung cancer (62% hospitalized, 25% died). Although severe, COVID-19 accounted for a minority of overall lung cancer deaths during the pandemic (11% overall). Determinants of COVID-19 severity were largely patient-specific features, including smoking status and chronic obstructive pulmonary disease [odds ratio for severe COVID-19 2.9, 95% confidence interval 1.07–9.44 comparing the median (23.5 pack-years) to never-smoker and 3.87, 95% confidence interval 1.35–9.68, respectively]. Cancer-specific features, including prior thoracic surgery/radiation and recent systemic therapies did not impact severity. Human leukocyte antigen supertypes were generally similar in mild or severe cases of COVID-19 compared with non-COVID-19 controls. Most patients recovered from COVID-19, including 25% patients initially requiring intubation. Among hospitalized patients, hydroxychloroquine did not improve COVID-19 outcomes. Conclusion
COVID-19 is associated with high burden of severity in patients with lung cancer. Patient-specific features, rather than cancer-specific features or treatments, are the greatest determinants of severity.