A Definitive Prognostication System for Patients With Thoracic Malignancies Diagnosed With Coronavirus Disease 2019: An Update From the TERAVOLT Registry

Abstract

Background Patients with thoracic malignancies are at increased risk for mortality from Coronavirus disease 2019 (COVID-19) and large number of intertwined prognostic variables have been identified so far. Methods Capitalizing data from the TERAVOLT registry, a global study created with the aim of describing the impact of COVID-19 in patients with thoracic malignancies, we used a clustering approach, a fast-backward step-down selection procedure and a tree-based model to screen and optimize a broad panel of demographics, clinical COVID-19 and cancer characteristics. Results As of April 15, 2021, 1491 consecutive evaluable patients from 18 countries were included in the analysis. With a mean observation period of 42 days, 361 events were reported with an all-cause case fatality rate of 24.2%. The clustering procedure screened approximately 73 covariates in 13 clusters. A further multivariable logistic regression for the association between clusters and death was performed, resulting in five clusters significantly associated with the outcome. The fast-backward step-down selection then identified seven major determinants of death ECOG-PS (OR 2.47 1.87-3.26), neutrophil count (OR 2.46 1.76-3.44), serum procalcitonin (OR 2.37 1.64-3.43), development of pneumonia (OR 1.95 1.48-2.58), c-reactive protein (CRP) (OR 1.90 1.43-2.51), tumor stage at COVID-19 diagnosis (OR 1.97 1.46-2.66) and age (OR 1.71 1.29-2.26). The ROC analysis for death of the selected model confirmed its diagnostic ability (AUC 0.78; 95%CI: 0.75 – 0.81). The nomogram was able to classify the COVID-19 mortality in an interval ranging from 8% to 90% and the tree-based model recognized ECOG-PS, neutrophil count and CRP as the major determinants of prognosis. Conclusion From 73 variables analyzed, seven major determinants of death have been identified. Poor ECOG-PS demonstrated the strongest association with poor outcome from COVID-19. With our analysis we provide clinicians with a definitive prognostication system to help determine the risk of mortality for patients with thoracic malignancies and COVID-19.

Coronavirus Disease 2019 Outcomes, Patient Vaccination Status, and Cancer-Related Delays During the Omicron Wave: A Brief Report From the TERAVOLT Analysis

“…In this analysis of the fourth COVID-19 wave, overall mortality of patients with thoracic malignancies in the TERAVOLT database was notably lower at 3.2% compared with 24.2% to 33% in prior surges. 1,2 This improvement in mortality is similar to that reported for the general population, with an analysis of patients hospitalized in South Africa with COVID-19 revealing a mortality of 2.7% in wave 4 compared with 19.7% in wave 1 (ancestral variant) and 29.1% in wave 3 (delta). 5 Our analysis reveals the importance of a booster vaccination to achieve the maximum protective effect from severe COVID-19 outcomes, including hospitalization or death (relative risk ¼ 0.30) in patients with thoracic cancer.…”

“…Prior analysis of mortality was 24.2% to 33%. 1,2 The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.529 (Omicron) variant was classified as a Variant of Concern by the WHO in November 2021. 3 Omicron was found to have the ability to evade existing SARS-CoV-2-neutralizing antibodies.…”

Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study

“…Patients with thoracic malignancies are at a high risk of mortality. 1 To prevent nosocomial transmission among patients and healthcare providers, visits, examinations, and procedures were restricted during the pandemic, and many focused efforts were underway, including pre-screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using real-time reverse transcription polymerase chain reaction (RT-qPCR) before hospitalization. The increase in the number of COVID-19 patients shifted the functioning of hospitals from general practice to COVID-19 care and decreased the availability of intensive care units (ICU) for surgeries.…”

Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations–State-of-the-Art

“…Of note, it should be taken into consideration that, mainly during the first pandemic waves, patients with cancer might not had equivalent access to ICU, a setting which is associated with increased risk of thrombosis (100). Interestingly, a recent study defining prognostic factors in patients with COVID-19 and thoracic malignancies did not identify coagulation-related factors as determinants of worse prognosis (101). Finally, it should be noted that the thrombotic and bleeding risks are heterogeneous across cancer sites, stages, or treatment and that the published cohorts, which in general include any cancer history, might not permit the estimation of the risk in a well-characterized population of patients with pro-thrombotic cancer types.…”