High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR

Cancer patients presenting with COVID-19 have a high risk of death. In this work, predictive factors for survival in cancer patients with suspected SARS-COV-2 infection were investigated. PRE-COVID-19 is a retrospective study of all 302 cancer patients presenting to this institute with a suspicion o...

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Published in:	European journal of cancer (1990) Vol. 135; pp. 251 - 259
Main Authors:	Assaad, Souad, Avrillon, Virginie, Fournier, Marie-Line, Mastroianni, Benedicte, Russias, Bruno, Swalduz, Aurélie, Cassier, Philippe, Eberst, Lauriane, Steineur, Marie-Pierre, Kazes, Marianne, Perol, Maurice, Michallet, Anne-Sophie, Rey, Philippe, Erena-Penet, Anne-Sophie, Morel, Astrid, Brahmi, Mehdi, Dufresne, Armelle, Tredan, Olivier, Chvetzoff, Gisèle, Fayette, Jérome, de la Fouchardiere, Christelle, Ray-Coquard, Isabelle, Bachelot, Thomas, Saintigny, Pierre, Tabutin, Mayeul, Dupré, Aurélien, Nicolas-Virelizier, Emmanuelle, Belhabri, Amine, Roux, Pierre-Eric, Fuhrmann, Christine, Pilleul, Franck, Basle, Alexandre, Bouhamama, Amine, Galvez, Christelle, Herr, Andrée-Laure, Gautier, Julien, Chabaud, Sylvie, Zrounba, Philippe, Perol, David, Blay, Jean-Yves
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01.08.2020 Elsevier The Author(s). Published by Elsevier Ltd
Subjects:	Age Factors Betacoronavirus - genetics Betacoronavirus - isolation & purification Cancer patients Clinical Laboratory Techniques - statistics & numerical data Coronavirus Infections - complications Coronavirus Infections - diagnosis Coronavirus Infections - mortality Coronavirus Infections - virology COVID-19 COVID-19 Testing COVID-19 Vaccines Female Follow-Up Studies Humans Karnofsky Performance Status - statistics & numerical data Life Sciences Male Middle Aged Mortality Neoplasm Recurrence, Local - complications Neoplasm Recurrence, Local - mortality Neoplasms - complications Neoplasms - mortality Original Research Pandemics Pneumonia, Viral - complications Pneumonia, Viral - diagnosis Pneumonia, Viral - mortality Pneumonia, Viral - virology Retrospective Studies Reverse Transcriptase Polymerase Chain Reaction - statistics & numerical data Risk Factors RNA, Viral - isolation & purification RT-PCR SARS-COV-2 Sex Factors Survival Survival Analysis Time Factors COVID-19 Cancer patients SARS-COV-2 Survival RT-PCR Risk factors
ISSN:	0959-8049, 1879-0852, 1879-0852
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Summary:	Cancer patients presenting with COVID-19 have a high risk of death. In this work, predictive factors for survival in cancer patients with suspected SARS-COV-2 infection were investigated. PRE-COVID-19 is a retrospective study of all 302 cancer patients presenting to this institute with a suspicion of COVID-19 from March 1st to April 25th 2020. Data were collected using a web-based tool within electronic patient record approved by the Institutional Review Board. Patient characteristics symptoms and survival were collected and compared in SARS-COV-2 real-time or reverse-transcriptase PCR (RT-PCR)–positive and RT-PCR–negative patients. Fifty-five of the 302 (18.2%) patients with suspected COVID-19 had detectable SARS-COV-2 with RT-PCR in nasopharyngeal samples. RT-PCR–positive patients were older, had more frequently haematological malignancies, respiratory symptoms and suspected COVID-19 pneumonia of computed tomography (CT) scan. However, respectively, 38% and 20% of SARS-COV-2 RT-PCR–negative patients presented similar respiratory symptoms and CT scan images. Thirty of the 302 (9.9%) patients died during the observation period, including 24 (80%) with advanced disease. At the median follow-up of 25 days after the first symptoms, the death rate in RT-PCR–positive and RT-PCR–negative patients were 21% and 10%, respectively. In both groups, independent risk factors for death were male gender, Karnofsky performance status <60, cancer in relapse and respiratory symptoms. Detection of SARS-COV-2 on RT-PCR was not associated with an increased death rate (p = 0.10). None of the treatment given in the previous month (including cytotoxics, PD1 Ab, anti-CD20, VEGFR2…) correlated with survival. The survival of RT-PCR–positive and –negative patients with respiratory symptoms and/or COVID-19 type pneumonia on CT scan was similar with a 18.4% and 19.7% death rate at day 25. Most (22/30, 73%) cancer patients dying during this period were RT-PCR negative. The 30-day death rate of cancer patients with or without documented SARS-COV-2 infection is poor, but the majority of deaths occur in RT-PCR–negative patients. •Cancer patients with SARS-COV-2 real-time or reverse-transcriptase PCR (RT-PCR have a death rate of 20% at 30 days.•Cancer patients with clinical symptoms of COVID-19 but SARS-COV-2 RT-PCR have high death rate.•70% cancer patients suspected COVID-19 dying before day 30 have no SARS-COV-2 on RT-PCR or computed tomography.•For both groups, the risk factors of death include "relapsing cancer", Karnofsky performance status <60, male gender, lymphopenia, and high CRP levels.•PD1 Ab, anti-CD20 and antiangiogenic treatments do not correlate with risk of death.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 PMCID: PMC7275994 All five authors contributed equally to this work (alphabetical order).
ISSN:	0959-8049 1879-0852 1879-0852
DOI:	10.1016/j.ejca.2020.05.028