Full Text:   <2414>

Summary:  <1449>

Suppl. Mater.: 

CLC number: 

On-line Access: 2021-10-12

Received: 2021-02-10

Revision Accepted: 2021-07-19

Crosschecked: 0000-00-00

Cited: 0

Clicked: 3892

Citations:  Bibtex RefMan EndNote GB/T7714


Dajing XIA


Yihua WU


-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE B 2021 Vol.22 No.10 P.876-884


Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis

Author(s):  Haohua LU, Yu SHI, Kelie CHEN, Zhi CHEN, Haihong ZHU, Yuequn NIU, Dajing XIA, Yihua WU

Affiliation(s):  Department of Toxicology of School of Public Health and Department of Gynecologic Oncology of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou310058, China; more

Corresponding email(s):   dxia@zju.edu.cn, georgewu@zju.edu.cn

Key Words:  COVID-19, Cancer, Anti-tumor regimens, Pooled analysis

Share this article to: More <<< Previous Article|

Haohua LU, Yu SHI, Kelie CHEN, Zhi CHEN, Haihong ZHU, Yuequn NIU, Dajing XIA, Yihua WU. Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis[J]. Journal of Zhejiang University Science B, 2021, 22(10): 876-884.

@article{title="Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis",
author="Haohua LU, Yu SHI, Kelie CHEN, Zhi CHEN, Haihong ZHU, Yuequn NIU, Dajing XIA, Yihua WU",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis
%A Haohua LU
%A Kelie CHEN
%A Haihong ZHU
%A Yuequn NIU
%A Dajing XIA
%A Yihua WU
%J Journal of Zhejiang University SCIENCE B
%V 22
%N 10
%P 876-884
%@ 1673-1581
%D 2021
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B2100151

T1 - Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis
A1 - Haohua LU
A1 - Yu SHI
A1 - Kelie CHEN
A1 - Zhi CHEN
A1 - Haihong ZHU
A1 - Yuequn NIU
A1 - Dajing XIA
A1 - Yihua WU
J0 - Journal of Zhejiang University Science B
VL - 22
IS - 10
SP - 876
EP - 884
%@ 1673-1581
Y1 - 2021
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B2100151

Since the outbreak of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) discovered in December 2019, the disease has emerged as a global pandemic (Shi et al., 2020; World Health Organization, 2020). Several studies have shown a higher incidence of COVID-19, as well as related poor outcomes in patients with malignancies as compared with those without them (Liang et al., 2020; Tian et al., 2020). The impact of cancer on COVID-19 may be attri‑buted to the use of antitumor treatments that may disturb the host response to SARS-CoV-2 infection (Wang et al., 2020), while the current studies on this topic have drawn controversial conclusions. Some implied that anticancer treatments might elevate the risk of death (García-Suárez et al., 2020; Liu et al., 2020). On the contrary, others pointed out that this association is not significant (Brar et al., 2020; Lee et al., 2020a). Although previous systematic reviews have investigated this important issue (Wang and Huang, 2020), the heterogeneity of findings is obvious and the general conclusion has remained unclear. Considering this ambiguity, it is difficult for clinicians to make therapeutic decisions when facing patients with both cancer and COVID-19; therefore, a high-quality and accurate evaluation of the impact of anticancer treatments on COVID-19 patients is necessary. Accordingly, we conducted a pooled analysis with the original data of each patient for the first time to provide a comprehensive perspective into the association between anticancer regimens and the outcomes of cancer patients with COVID-19.


概要:不同的肿瘤治疗方案可能是肿瘤合并新型冠状病毒肺炎(COVID-19)患者预后较差的原因之一,但是目前相关研究却仍未有定论。因此,全面深入的分析可以辅助临床医生选择和制定新型冠状病毒流行期间的抗肿瘤治疗方案。我们通过从PubMed、Embase和Cochrane数据库检索得到的提供了每个患者临床信息的11项相关研究展开汇总分析。本研究发现化疗是这些COVID-19合并肿瘤的患者中最常见的抗肿瘤治疗。经过对混杂因素的调整,抗肿瘤治疗方案对患者结局的影响并不显著。值得关注的是,在对于化疗和激素治疗的研究中,高龄(≥65岁)会增加这类患者发生死亡(化疗的研究中比值比(OR)=2.36,95%的置信区间(95% CI)=1.11~5.01,P=0.025;激素治疗的研究中OR=2.29;95% CI=1.08~4.85,P=0.03)及严重事件(OR=2.72,95% CI=1.45~5.10,P=0.002)的可能性,心脑血管疾病病史则会增加这类患者发生严重事件的可能性(OR=1.91;95% CI=1.02~3.57,P=0.043)。在进一步的亚组分析中,我们发现免疫治疗可能会显著增加患有实体肿瘤的新型冠状病毒患者死亡(OR=2.66,95% CI=1.07~6.64,P=0.03)和发生严重事件(OR=5.04,95% CI=1.02~24.86,P=0.039)的可能性,而化疗则可能显著增加患有血液系统肿瘤的新型冠状病毒患者死亡的可能性(OR=4.11,95% CI=1.59~10.6,P=0.003)。综上所述,在多因素模型中,相较于不同的肿瘤治疗方案,影响肿瘤合并COVID-19患者预后的关键临床因素如年龄、心脑血管病等,可能更为关键。在亚组分析中,免疫治疗和化疗则可能分别对实体肿瘤患者和血液肿瘤患者有较为显著的影响。


Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]BertuzziAF, MarrariA, GennaroN, et al., 2020. Low incidence of SARS-CoV-2 in patients with solid tumours on active treatment: an observational study at a tertiary cancer centre in Lombardy, Italy. Cancers, 12(9):2352.

[2]BiernatMM, ZińczukA, BiernatP, et al., 2020. Nosocomial outbreak of SARS-CoV-2 infection in a haematological unit—high mortality rate in infected patients with haematologic malignancies. J Clin Virol, 130:104574.

[3]BoganiG, DittoA, BosioS, et al., 2020. Cancer patients affected by COVID-19: experience from Milan, Lombardy. Gynecol Oncol, 158(2):262-265.

[4]BoothS, WillanJ, WongHN, et al., 2020. Regional outcomes of severe acute respiratory syndrome coronavirus 2 infection in hospitalised patients with haematological malignancy. Eur J Haematol, 105(4):476-483.

[5]BrarG, PinheiroLC, ShustermanM, et al., 2020. COVID-19 severity and outcomes in patients with cancer: a matched cohort study. J Clin Oncol, 38(33):3914-3924.

[6]DaiMY, LiuDB, LiuM, et al., 2020. Patients with cancer appear more vulnerable to SARS-CoV-2: a multicenter study during the COVID-19 outbreak. Cancer Discov, 10(6):783-791.

[7]FreyMK, FowlkesRK, BadinerNM, et al., 2020. Gynecologic oncology care during the COVID-19 pandemic at three affiliated New York City hospitals. Gynecol Oncol, 159(2):470-475.

[8]García-SuárezJ, de la CruzJ, CedilloÁ, et al., 2020. Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study. J Hematol Oncol, 13:133.

[9]GrivasP, KhakiAR, Wise-DraperTM, et al., 2021. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and cancer consortium. Ann Oncol, 32(6):787-800.

[10]Joharatnam-HoganN, HochhauserD, ShiuKK, et al., 2020. Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: a multi-centre North London experience. Ther Adv Med Oncol, 12:1758835920956803.

[11]KalinskyK, AccordinoMK, HosiK, et al., 2020. Characteristics and outcomes of patients with breast cancer diagnosed with SARS-CoV-2 infection at an academic center in New York City. Breast Cancer Res Treat, 182:239-242.

[12]KennedyLB, SalamaAKS, 2020. A review of cancer immunotherapy toxicity. CA: Cancer J Clin, 70(2):86-104.

[13]LeeLYW, CazierJB, AngelisV, et al., 2020a. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet, 395(10241):1919-1926.

[14]LeeLYW, CazierJB, StarkeyT, et al., 2020b. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol, 21(10):1309-1316.

[15]LiangW, GuanW, ChenR, et al., 2020. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol, 21(3):335-337.

[16]LinDD, WuYH, ToomS, et al., 2021. Clinical determinants differentiating the severity of SARS-CoV-2 infection in cancer patients: hospital care or home recovery. Front Med (Lausanne), 8:604221.

[17]LiuC, LiL, SongKH, et al., 2020. A nomogram for predicting mortality in patients with COVID-19 and solid tumors: a multicenter retrospective cohort study. J Immunother Cancer, 8(2):e001314

[18]LiuY, LuH, WangW, et al., 2021. Clinical risk factors for mortality in patients with cancer and COVID-19: a systematic review and meta-analysis of recent observational studies. Expert Rev Anticancer Ther, 21(1):107-119.

[19]MotzGT, CoukosG, 2013. Deciphering and reversing tumor immune suppression. Immunity, 39(1):61-73.

[20]NakamuraS, KanemasaY, AtsutaY, et al., 2021. Characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients with cancer: a single-center retrospective observational study in Tokyo, Japan. Int J Clin Oncol, 26(3):485-493.

[21]RüthrichMM, Giessen-JungC, BorgmannS, et al., 2021. COVID-19 in cancer patients: clinical characteristics and outcome—an analysis of the LEOSS registry. Ann Hematol, 100(2):383-393.

[22]SchönrichG, RafteryMJ, 2019. The PD-1/PD-L1 axis and virus infections: a delicate balance. Front Cell Infect Microbiol, 9:207.

[23]SharafeldinN, BatesB, SongQ, et al., 2021. Outcomes of COVID-19 in patients with cancer: report from the National COVID Cohort Collaborative (N3C). J Clin Oncol, 39(20):2232-2246.

[24]ShiY, WangG, CaiXP, et al., 2020. An overview of COVID-19. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 21(5):343-360.

[25]ShumilovE, HoffknechtP, KochR, et al., 2021. Diagnostic, clinical and post-SARS-CoV-2 scenarios in cancer patients with SARS-CoV-2: retrospective analysis in three German cancer centers. Cancers (Basel), 13(12):2917.

[26]TianJB, YuanXL, XiaoJ, et al., 2020. Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncol, 21(7):893-903.

[27]WangBL, HuangY, 2020. Immunotherapy or other anti-cancer treatments and risk of exacerbation and mortality in cancer patients with COVID-19: a systematic review and meta-analysis. OncoImmunology, 9(1):1824646.

[28]WangLQ, YinETS, WeiGQ, et al., 2020. Weathering the storm: COVID-19 infection in patients with hematological malignancies. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 21(12):921-939.

[29]World Health Organization, 2020. WHO Director-General’s opening remarks at the media briefing on COVID-‍19‒20 November 2020.https://www.who.int/director-general/speeches/detail/who-director-‍general-s-opening-remarks-at-the-media-briefing-on-covid-‍19---20-november-2020

[30]WuQJ, ChuQ, ZhangHY, et al., 2020. Clinical outcomes of coronavirus disease 2019 (COVID-19) in cancer patients with prior exposure to immune checkpoint inhibitors. Cancer Commun, 40(8):374-379.

[31]XuZ, ShiL, WangYJ, et al., 2020. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med, 8(4):420-422.

[32]YangY, 2015. Cancer immunotherapy: harnessing the immune system to battle cancer. J Clin Invest, 125(9):3335-3337.

[33]YazakiS, YoshidaT, KojimaY, et al., 2021. Difference in SARS-CoV-2 antibody status between patients with cancer and health care workers during the COVID-19 pandemic in Japan. JAMA Oncol, 7(8):1141-1148.

[34]ZhangHY, WangLW, ChenYY, et al., 2020. Outcomes of novel coronavirus disease 2019 (COVID-19) infection in 107 patients with cancer from Wuhan, China. Cancer, 126(17):4023-4031.

[35]ZhangL, ZhuF, XieL, et al., 2020. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol, 31(7):894-901.

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE