作者投稿
专家审稿
编辑办公
邮件订阅
RSS
-
摘要:
目的 调查Omicron变异株大流行期间肿瘤患者发生新型冠状病毒(下文简称“新冠”)感染的情况。 方法 2022年12月25日至2023年1月25日，通过问卷星平台以电子问卷的方式收集恶性肿瘤患者(包括既往于北京协和医院肿瘤内科就诊及于北京协和医院肿瘤内科进修医生所在当地医院肿瘤内科就诊的患者)接种新冠疫苗、调查期间(自2022年12月9日至问卷调查时)感染新冠、临床症状、感染后抗肿瘤治疗等相关信息，并进行统计学分析。 结果 共发放调查问卷270份，回收有效问卷265份, 有效回收率为98.1%。265例恶性肿瘤患者中，接种新冠疫苗170例(64.2%)，带瘤生存158例(59.6%)，感染新冠时或调查期间正在抗肿瘤治疗216例(81.5%); 感染新冠210例(79.2%)，其中发生新冠肺炎9例(4.3%)，因新冠肺炎住院治疗3例(1.4%)，无重症及死亡病例。新冠感染者中，205例(97.6%)出现新冠相关症状，其中以发热最为常见(72.9%)，呼吸道症状以咳嗽(64.8%)、咳痰(50.5%)为主。新冠感染者与未感染者在性别、年龄、肿瘤类型、有/无基础疾病、是/否接种新冠疫苗、是/否正在抗肿瘤治疗方面均无显著差异(P均＞0.05)。新冠感染者中，疫苗接种≥3剂者新冠肺炎发生率显著低于未接种者(1.1%比9.9%, P=0.025)。截至问卷调查时, 88例患者于新冠感染后已开启抗肿瘤治疗，其中与感染前相比，感染后抗肿瘤治疗不良反应更严重12例(13.6%)，症状相近64例(72.7%)，症状更轻微12例(13.6%)。感染新冠前后抗肿瘤治疗不良反应变化与感染后开启抗肿瘤治疗时机无明显相关(P=0.938)，而与感染后抗肿瘤治疗方式具有一定相关性(P=0.003)。 结论 Omicron变异株大流行期间肿瘤患者对新冠普遍易感，几乎所有感染者均出现了相关临床症状，极少数发生新冠肺炎。接种≥3剂疫苗可能对新冠肺炎具有预防作用。多数肿瘤患者感染新冠后抗肿瘤治疗的不良反应较感染前无明显加重。 -
关键词:
- 肿瘤 /
- 新型冠状病毒感染 /
- Omicron变异株 /
- 症状
Abstract:Objective To investigate the incidence of COVID-19 in patients with tumor during the pandemic of Omicron variant strains. Methods From December 25, 2022 to January 25, 2023, through the questionnaire star platform in the form of electronic questionnaire, we collected information about COVID-19 vaccine, COVID-19 infection and clinical symptoms, and post-infection anti-tumor therapy of patients with malignant tumors (including patients who previously visited the oncology department of Peking Union Medical College Hospital and the oncology department of the local hospital where the trainee doctors of the oncology department of Peking Union Medical College Hospital are located) during the survey period (from December 9, 2022 to the time of questionnaire survey) and performed statistical analysis. Results A total of 270 questionnaires were sent out, of which 265 valid questionnaires were recovered (the effective questionnaire rate was 98.1%). Among the 265 patients with malignant tumors, 170(64.2%) patients received COVID-19 vaccine, 158(59.6%) patients were alive with tumor, and 216 patients (81.5%) were receiving antitumor therapy at the time of COVID-19 infection or during the investigation. In 210 cases (79.2%), patients were infected with COVID-19. Among them, 9 cases (4.3%) developed COVID-19 pneumonia and 3 cases (1.4%) were hospitalized due to COVID-19, and there were no severe or fatal cases. Among the infected patients, 205(97.6%) patients showed symptoms related to the COVID-19, among which fever was the most common (72.9%) symptom, and cough (64.8%) and sputum (50.5%) were the main respiratory symptoms. There were no significant differences in gender, age, tumor type, whether they had underlying diseases, whether they were vaccinated against COVID-19, and whether they were treated with anti-tumor therapy between COVID-19 infected and uninfected patients (all P > 0.05). Among the infected patients, the incidence of pneumonia in those who received ≥3 doses of vaccine was significantly lower than that in those who did not receive vaccine (1.1% vs. 9.9%, P=0.025). At the time of questionnaire survey, 88 patients started antitumor therapy after COVID-19 infection. Compared to infection before COVID-19, 12 patients(13.6%) had more serious adverse anti-tumor reactions after COVID-19 infection, 63 patients (72.7%) had similar symptoms, and 12 patients (13.6%) had milder symptoms. There was no significant correlation between the adverse reactions of anti-tumor therapy before and after infection and the timing of initiation of anti-tumor therapy after infection(P=0.938), but there was a certain correlation with anti-tumor therapy after infection(P=0.003). Conclusions During the pandemic period of Omicron variant, tumor patients were generally susceptible to COVID-19. Almost all infected patients showed related clinical symptoms, but very few patients developed pneumonia. Vaccination with≥3 doses of vaccine may be protective against pneumonia. The adverse reactions of anti-tumor therapy in most cancer patients after infection with COVID-19 were not significantly worse than those before infection. -
Key words:
- tumor /
- COVID-19 /
- Omicron mutant /
- symptom
作者贡献：刘宛榕负责数据收集与分析、论文撰写；唐辉负责问卷设计、数据收集与分析；周娜、邱维、李孝远负责查阅文献、问卷发放；王湘、白春梅、周建凤负责数据统计；赵林负责研究设计、论文修订。利益冲突：所有作者均声明不存在利益冲突 -
表 1 265例恶性肿瘤患者基本资料[n(%)]
指标 数值 年龄(岁) ≤30 1(0.4) 31~40 14(5.3) 41~50 39(14.7) 51~60 80(30.2) 61~70 88(33.2) 71~80 37(14.0) ≥81 6(2.3) 性别 男 142(53.6) 女 123(46.4) 体质量指数(kg/m2) ＜18 11(4.2) 18~24 163(61.5) ＞24 91(34.3) 吸烟 从不 162(61.1) 曾吸烟，现已戒烟 85(32.1) 目前仍吸烟 18(6.8) 肿瘤类型 胰腺癌 37(14.0) 食管癌 10(3.8) 肠癌 105(39.6) 肺癌 18(6.8) 肝癌 7(2.6) 胃癌 16(6.0) 胆管癌 3(1.1) 其他 69(26.0) 带瘤生存 是 158(59.6) 否 74(27.9) 不确定 33(12.5) 正在抗肿瘤治疗 是 216(81.5) 否 49(18.5) 基础疾病 无 112(42.3) 有 153(57.7) 接种新冠疫苗(剂) 0 95(35.8) 1 8(3.0) 2 47(17.7) ≥3 115(43.4) 
下载: 导出CSV
表 2 210例新冠感染者临床资料[n(%)]
指标 数值 发热 153(72.9) 发热时最高体温(℃) 37.3~38 25(16.3) ＞38~39 104(68.0) ＞39~40 22(14.4) ＞40 1(0.7) 不详 1(0.7) 发热持续时间(d) ≤3 121(79.1) ＞3 32(20.9) 症状 咳嗽 136(64.8) 咳痰呼吸困难 106(50.5) 乏力 12(5.7) 头晕 132(62.9) 鼻塞 39(18.6) 流涕 58(27.6) 喷嚏 60(28.6) 头痛 34(16.2) 咽痛 51(24.3) 肌肉酸痛 82(39.1) 恶心 76(36.2) 食欲减退 30(14.3) 呕吐 70(33.3) 腹泻 17(8.1) 声音嘶哑 25(11.9) 嗜睡 31(14.8) 其他 28(13.3) 与周围非肿瘤患者相比，症状严重程度 更严重 26(12.4) 相近 105(50.0) 更轻微 79(37.6) 发生新冠肺炎 9(4.3) 因新冠肺炎住院 3(1.4) 用药情况 中成药或非甾体抗炎药 167(79.5) Paxlovid 2(1.0) 未用药 41(19.5)
下载: 导出CSV
表 3 新冠感染者与未感染者临床特征比较[n(%)]
指标 新冠感染者(n=210) 未感染者(n=55) P值 性别 0.284 男(n=142) 109(76.8) 33(23.2) 女(n=123) 101(82.1) 22(17.9) 年龄(岁) 0.255 21~40(n=15) 14(93.3) 1(6.7) 41~60(n=119) 90(75.6) 29(24.3) ≥61(n=131) 106(80.9) 25(19.1) 肿瘤类型 0.237 肺癌(n=19) 18(94.7) 1(5.3) 消化系统肿瘤(n=183) 142(77.6) 41(22.4) 其他(n=63) 50(79.4) 13(20.6) 基础疾病 0.817 有(n=153) 122(79.7) 31(20.3) 无(n=112) 88(78.6) 24(21.4) 接种新冠疫苗 0.799 未接种(n=95) 77(81.1) 18(18.9) 接种1~2剂(n=55) 44(80.0) 11(20.0) 接种≥3剂(n=115) 89(77.4) 26(22.6) 正在抗肿瘤治疗 0.216 是(n=216) 168(77.8) 48(22.2) 否(n=49) 42(85.7) 7(14.3)
下载: 导出CSV
表 4 肺炎患者与非肺炎患者的基本资料比较[n(%)]
指标 肺炎患者(n=11) 非肺炎患者(n=199) P值 性别 0.660 男(n=109) 5(4.6) 104(95.4) 女(n=101) 6(5.9) 95(94.1) 年龄(岁) 0.702 21~40(n=14) 0(0) 14(100) 41~60(n=90) 4(4.4) 86(95.6) ≥61(n=106) 7(6.6) 99(93.4) 吸烟史 0.206 有(n=84) 2(2.4) 82(97.6) 无(n=126) 9(7.1) 117(92.9) 肿瘤类型 0.294 肺癌(n=18) 2(11.1) 16(88.9) 消化系统肿瘤(n=142) 6(4.2) 136(95.8) 其他(n=50) 3(6.0) 47(94.0) 基础疾病 0.101 有(n=122) 9(7.4) 113(92.6) 无(n=88) 2(2.3) 86(97.7) 接种新冠疫苗 0.041 未接种(n=77) 7(9.1) 70(90.9) 接种1~2剂(n=44) 3(6.8) 41(93.2) 接种≥3剂(n=89) 1(1.1) 88(98.9) 正在抗肿瘤治疗 0.126 是(n=168) 11(6.5) 157(93.5) 否(n=42) 0(0) 42(100)
下载: 导出CSV
表 5 感染新冠后开启抗肿瘤治疗时机、抗肿瘤治疗方式与不良反应变化的相关性[n(%)]
指标 与感染新冠前相比，感染后抗肿瘤治疗不良反应 P值 更严重 更轻微 相近 感染后开启抗肿瘤治疗的时机 0.938 核酸/抗原转阴(n=80) 12(15.0) 11(13.7) 57(71.3) 核酸/抗原阳性(n=8) 0(0) 1(12.5) 7(87.5) 感染后抗肿瘤治疗方式 0.003 化疗(n=55) 7(12.7) 7(12.7) 41(74.5) 靶向治疗(n=17) 1(5.9) 1(5.9) 15(88.2) 内分泌治疗(n=11) 3(27.3) 2(18.2) 6(54.5) 免疫治疗(n=8) 2(25.0) 5(62.5) 1(12.5)
下载: 导出CSV
-
[1] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395: 497-506. doi: 10.1016/S0140-6736(20)30183-5 [2] World Health Organization. WHO coronavirus(COVID-19)dashboard[EB/OL]. (2023-03-31)[2023-03-31]. https://covid19.who.int/table .[3] World Health Organization. update on Omicron[EB/OL]. (2021-11-28)[2023-06-07]. https://www.who.int/zh/news/item/28-11-2021-update-on-omicron .[4] Madhi S, Kwatra G, Myers JE, et al. Population Immunity and COVID-19 Severity with Omicron Variant in South Africa[J]. N Engl J Med, 2022, 386: 1314-1326. doi: 10.1056/NEJMoa2119658 [5] 中国疾病控制中心. 全国新型冠状病毒感染疫情情况[EB/OL]. (2023-03-04)[2023-06-07]. https://www.chinacdc.cn/jkzt/crb/zl/szkb_11803/jszl_13141/202303/t20230304_264035.html .[6] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66: 115-132. doi: 10.3322/caac.21338 [7] 吴俣, 刘珏, 刘民, 等. 新型冠状病毒Omicron变异株亚型BA. 4与BA. 5的流行病学特征及防控研究[J]. 中国全科医学, 2022, 25: 3721-3725. doi: 10.12114/j.issn.1007-9572.2022.0538 [8] Wolter N, Jassat W, Walaza S, et al. Early assessment of the clinical severity of the SARS-CoV-2 omicron variant in South Africa: a data linkage study[J]. Lancet, 2022, 399: 437-446. doi: 10.1016/S0140-6736(22)00017-4 [9] 刘晓芳, 陈美平, 周志国, 等. 17例新型冠状病毒Omicron变异株境外输入感染者的流行病学特征[J]. 中南大学学报(医学版), 2022, 47: 344-351. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD202203009.htm [10] Callaway E, Ledford H. How bad is Omicron? What scientists know so far[J]. Nature, 2021, 600: 197-199. doi: 10.1038/d41586-021-03614-z [11] Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China[J]. Lancet Oncol, 2020, 21: 335-337. doi: 10.1016/S1470-2045(20)30096-6 [12] Dai M, Liu D, Liu M, et al. Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak[J]. Cancer Discov, 2020, 10: 783-791. doi: 10.1158/2159-8290.CD-20-0422 [13] Pinato D, Aguilar-Company J, Ferrante D, et al. Outcomes of the SARS-CoV-2 Omicron (B. 1.1.529) variant outbreak among vaccinated and unvaccinated patients with cancer in Europe: results from the retrospective, multicentre, OnCovid registry study[J]. Lancet Oncol, 2022, 23: 865-875. doi: 10.1016/S1470-2045(22)00273-X [14] Kim M, Lee B, Choi Y, et al. Clinical Characteristics of 40 Patients Infected With the SARS-CoV-2 Omicron Variant in Korea[J]. J Korean Med Sci, 2022, 37: e31. doi: 10.3346/jkms.2022.37.e31 [15] Meo S, Meo A, Al-Jassir F. Omicron SARS-CoV-2 new variant: global prevalence and biological and clinical characteristics[J]. Eur Rev Med Pharmacol Sci, 2021, 25: 8012-8018. [16] Thakkar A, Gonzalez-Lugo J, Goradia N, et al. Seroconversion rates following COVID-19 vaccination among patients with cancer[J]. Cancer Cell, 2021, 39: 1081-1090 e2. doi: 10.1016/j.ccell.2021.06.002 [17] Wu J, La J, Branch-Elliman W, et al. Association of COVID-19 Vaccination With SARS-CoV-2 Infection in Patients With Cancer: A US Nationwide Veterans Affairs Study[J]. JAMA Oncol, 2022, 8: 281-286. doi: 10.1001/jamaoncol.2021.5771 [18] Lee L, Cazier J, Angelis V, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study[J]. Lancet, 2020, 395: 1919-1926. doi: 10.1016/S0140-6736(20)31173-9 [19] Varnai C, Palles C, Arnold R, et al. Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19[J]. JAMA Netw Open, 2022, 5: e220130. doi: 10.1001/jamanetworkopen.2022.0130 [20] 中国抗癌协会肿瘤支持治疗专业委员会, 中国抗癌协会肿瘤临床化疗专业委员会. 新型冠状病毒肺炎疫情期间实体肿瘤患者防护和诊治管理相关问题中国专家共识(2022版)[J]. 中华肿瘤杂志, 2022, 44: 1083-1090. -
点击查看大图
表(5)
计量
- 文章访问数: 170
- HTML全文浏览量: 41
- PDF下载量: 19
- 被引次数: 0
