J Cancer 2021; 12(12):3558-3565. doi:10.7150/jca.54205

Research Paper

Severity of COVID-19 in Cancer patients versus patients without Cancer: A Propensity Score Matching Analysis

Chao Liu1,2#, Kai Wang3#, Luyuan Li4#, Qingquan Lv5, Yumei Liu6, Tian Hu6, Jonathan C. Trent4✉, Bing Sun7✉, Qinyong Hu1✉

1. Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China.
2. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
3. Department of Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
4. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA.
5. Department of Medical Affairs, Wuhan Hankou Hospital, Wuhan, China.
6. Department of Respiratory Medicine, Wuhan Hankou Hospital, Wuhan, China.
7. Department of Radiation Oncology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
#These authors contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Liu C, Wang K, Li L, Lv Q, Liu Y, Hu T, Trent JC, Sun B, Hu Q. Severity of COVID-19 in Cancer patients versus patients without Cancer: A Propensity Score Matching Analysis. J Cancer 2021; 12(12):3558-3565. doi:10.7150/jca.54205. Available from https://www.jcancer.org/v12p3558.htm

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Purpose: Data are extremely limited with regards to the impact of COVID-19 on cancer patients. Our study explored the distinct clinical features of COVID-19 patients with cancer.

Experimental Design: 189 COVID-19 patients, including 16 cancer patients and 173 patients without cancer, were recruited. Propensity score 1:4 matching (PSM) was performed between cancer patients and patients without cancer based on age, gender and comorbidities. Survival was calculated by the Kaplan-Meier method and the difference was compared by the log-rank test.

Results: PSM analysis yielded 16 cancer patients and 64 propensity score-matched patients without cancer. Compared to patients without cancer, cancer patients tended to have leukopenia and elevated high-sensitivity C-reactive protein (hs-CRP) and procalcitonin. For those with critical COVID-19, cancer patients had an inferior survival than those without cancer. Also, cancer patients with severe/critical COVID-19 tended to be male and present with low SPO2 and albumin, and high hs-CRP, lactate dehydrogenase and blood urea nitrogen on admission compared to those with mild COVID-19. In terms of risk factors, recent cancer diagnosis (within 1 year of onset of COVID-19) and anti-tumor treatment within 3 months of COVID-19 diagnosis were associated with inferior survival.

Conclusions: We found COVID-19 patients with cancer have distinct clinical features as compared to patients without cancer. Importantly, cancer patients with critical COVID-19 were found to have poorer outcomes compared to those without cancer. In the cancer cohort, patients with severe/critical COVID-19 presented with a distinct clinical profile from those with mild COVID-19; short cancer history and recent anti-cancer treatment were associated with inferior survival.

Keywords: COVID-19, clinical characteristics, survival, propensity score matching, cancer