Outcome of liver cancer patients with SARS‐CoV‐2 infection: An International, Multicentre, Cohort Study

Abstract

Background & Aims: Information about the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with liver cancer is lacking. This study characterizes the outcomes and mortality risk in this population.Methods: Multicentre retrospective, cross-sectional, international study of liver cancer patients with SARS-CoV-2 infection registered between February and December 2020. Clinical data at SARS-CoV-2 diagnosis and outcomes were registered.Results: Two hundred fifty patients from 38 centres were included, 218 with hepatocellular carcinoma (HCC) and 32 with intrahepatic cholangiocarcinoma (iCCA).The median age was 66.5 and 64.5 years, and 84.9% and 21.9% had cirrhosis in the HCC and iCCA cohorts respectively. Patients had advanced cancer stage at SARS-CoV-2 diagnosis in 39.0% of the HCC and 71.9% of the iCCA patients. After a median follow-up of 7.20 (IQR: 1.84-11.24) months, 100 (40%) patients have died, 48% of the deaths were SARS-CoV-2-related. Forty (18.4%) HCC patients died within 30-days. The death rate increase was significantly different according to the BCLC stage (6.10% [95% CI 2.24-12.74], 11.76% ] and 34.52% [95% CI 17.03-52.78] for BCLC 0/A, B, C and D, respectively; p = .0017). The hazard ratio was 1.45 (95% CI 0.49-4.31; p = .5032) in BCLC-B versus 0/A, and 3.13 (95% CI 1.29-7.62; p = .0118) in BCLC-C versus 0/A in the competing risk Cox regression model. Nineteen out of 32 iCCA (59.4%) died, and 12 deaths were related to SARS-CoV-2 infection.Conclusions: This is the largest cohort of liver cancer patients infected with SARS-CoV-2. It characterizes the 30-day mortality risk of SARS-CoV-2 infected patients with HCC during this period.

COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management

“…Cancer patients have a higher risk of SARS-CoV-2 infection and a worse prognosis than noncancer patients, and patients with high-risk tumors, especially those with an NRS2002 score ≥ 3 and advanced tumor stages, may have higher mortality [126] , [127] . The risk of death in cancer patients infected with COVID-19 is mainly influenced by age, sex and comorbidities and is independent of whether they have had radiotherapy, targeted therapy, immunotherapy, or hormonal therapy within the past 4 weeks [128] .…”

“…However, the trial had a small number of patients with HCC. In a large study of liver cancer patients infected with SARS-CoV-2, 52 patients died within 30 days of infection, and 43 (82.7%) of these deaths were related to SARS-CoV-2 infection [127] . In a follow-up study of patients with HCC, the COVID-19 pandemic led to a longer follow-up interval for patients, which may reduce the overall response rate of patients, and the prognosis of patients was worse when the follow-up interval was >95 days [129] .…”

Impact of chronic liver disease on SARS-CoV-2 infection outcomes: Roles of stage, etiology and vaccination

“…Although data are not univocal[ 25 ], several studies include the presence of HCC among the independent predictors of COVID-19-related mortality[ 15 , 30 , 38 ]. Among patients with CLD and COVID-19, HCC patients had 3.31 times the hazard of death for all causes, regardless of the presence of liver cirrhosis[ 30 ].…”

COVID-19: Has the Liver Been Spared?

“…Several studies reported a significant decrease in the number of new HCCs diagnosed (up to 37%) during the pandemic, which is in marked contrast to the steady increases in previous years and suggests that incident cases went undiagnosed during this period [ 168 , 169 ]. In addition, HCCs diagnosed following the COVID-19 outbreak were significantly larger and more frequently associated with lymphadenopathy and extrahepatic disease, with a consequent shift toward a higher tumor burden at diagnosis.…”