A Systematic Review and Meta-Analysis of Clinical Characteristics and Outcomes in Patients With Lung Cancer with Coronavirus Disease 2019

Abstract

Cancer is considered to be an independent risk factor for severe illness and higher mortality in patients with coronavirus disease 2019 (COVID-19). These adverse outcomes have been suspected to be more severe in patients with lung cancer. The objective of this systematic review and meta-analysis is to outline patient characteristics, challenges in diagnosis and treatment, and outcomes of patients with lung cancer with COVID-19. A comprehensive search was conducted using EMBASE and PubMed databases using the terms "COVID" and "cancer." Studies that reported clinical characteristics or outcomes of patients with lung cancer with COVID-19 were then systematically identified. Meta-analysis for COVID-19 related mortality associated with lung cancer compared with other cancer types was conducted. The results were reported as OR and confidence intervals using the mixedeffects logistic regression model. The most frequently reported clinical findings in patients with lung cancer with COVID-19 were fever and cough, with 68% and 61%, respectively. Laboratory and radiographic findings were consistent with broadly reported data. The meta-analysis noted a statistically significant increase in mortality rate in patients with lung cancer compared with other patients with cancer, with an OR of 1.62 (95% confidence interval: 1.06-2.48). Patients with lung cancer with COVID-19 also reflected greater severity of illness and higher rates of intensive care unit admissions and mechanical ventilation. COVID-19 in patients with lung cancer is associated with severe disease and increased mortality relative to patients with other malignancies and the general population. There is conflicting evidence on the effect of specific lung cancer treatments on outcomes. Until more definitive data is available, lung cancer-directed treatment should be continued or restarted as early as possible in mild to moderate cases to prevent worsening and cancer-related mortality.

Outcomes and Prognostic Factors in a Large Cohort of Hospitalized Cancer Patients With COVID-19

“… 9 As the lung is one of the target organs more commonly affected by COVID-19, the lung involvement by neoplasia could be associated with higher rates and severity of respiratory complications, possibly as a result of worse baseline lung function. 16 …”

“…9 As the lung is one of the target organs more commonly affected by COVID-19, the lung involvement by neoplasia could be associated with higher rates and severity of respiratory complications, possibly as a result of worse baseline lung function. 16 Another point of interest was the possible impact that cancer therapies could have on the outcomes of patients with COVID-19, since these treatments commonly lead to immunologic modulation including suppression 3 or stimulation. 17 The outcomes of SARS-Cov-2 infection appear to be largely determined by the inflammatory response triggered by the virus.…”

Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis

“…This systematic review has several strengths. Unlike previous meta-analyses on related topics [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], this study: (i) involves a comprehensive analysis of a large number of studies that are based in different countries in the world; (ii) includes many articles that were published in 2021, after the introduction of the Delta strain; (iii) analyzes only peer-reviewed data; (iv) assesses the extensive analysis of the source of the heterogeneity and bias in the studies; and (v) compares the risk of admission to the ICU vs. no admission among hospitalized COVID-19 patients, and is stratified on the basis of comorbidities and demographic status.…”

“…However, the associations with other comorbidities have been less clear, such as with cancer, chronic liver disease, diabetes, and kidney disease. While several meta-analyses studies report an increased risk of death in COVID-19 patients with diabetes [ 5 , 11 , 19 ], cancer [ 20 , 21 , 22 ], liver disease [ 23 , 24 , 25 ], and kidney disease [ 26 , 27 , 28 , 29 ], some report the lack of correlation between these comorbidities and the disease progression or the clinical outcomes of COVID-19 patients [ 30 , 31 , 32 ].…”

Quels malades peuvent et doivent aller en réanimation ?

“…Dans l’étude TERAVOLT [ 43 ], sur 200 patients inclus entre mars et avril 2020 présentant un cancer bronchique et une infection à Covid-19, 152 ont été hospitalisés, 134 remplissaient les critères d’une admission en soins intensifs (88 %), mais seuls 13 (10 %) ont été admis en soins intensifs, parmi lesquels 9 ont bénéficié d’une ventilation mécanique. Des résultats similaires ont été retrouvés sur des études de cohorte nationales, en particulier dans l’étude GRAVID en Espagne [ 46 ], bien que le taux d’admission en soins intensifs varie d’une cohorte à l’autre [ 47 , 48 ]. L’étude TERAVOLT a également permis de montrer que seuls 33 % des patients atteints de cancer bronchique et hospitalisés pour Covid-19 ont repris leur traitement anti cancéreux [ 44 ].…”