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04-02-2022 | Oncology | News | Article

Seven factors linked to COVID-19 mortality risk in thoracic cancer patients

Author: Lynda Williams

medwireNews: TERAVOLT registry investigators have identified seven major risk factors for COVID-19 mortality in patients with thoracic malignancy, with poor ECOG performance status (PS) the strongest prognostic marker.

“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,” say Alessio Cortellini, from Imperial College London in the UK, and co-workers.


The team collated information for 1491 patients from 19 countries who were entered into the TERAVOLT registry between March 2020 and April 2021. The majority (96%) of patients had confirmed SARS-CoV-2 infection, while 4% had suspicious radiological or clinical findings for the infection.

The majority of patients were male (57.3%), White (72.2%), and former or current smokers (77.8%), and their median age was 67 years. Overall, 82.3% of patients had one or more comorbidities, such as hypertension (48.0%), chronic obstructive pulmonary disease (24.5%), or diabetes (19.3%).

The most common malignancy was non-small-cell lung cancer (79.7%), 67.8% of patients had stage IV disease at time of COVID-19 diagnosis, and 71.9% had a good ECOG PS of 0–1. Of note, 64.5% had received anticancer therapy within 3 months of infection, most commonly chemotherapy given alone (38.3%).

The patients were treated for COVID-19 with antibiotics (48.7%), anticoagulants (37.2%), corticosteroids (33.4%); antiviral (18.9%) antimalarial (16.4%) and antifungal (2.6%) agents; and interleukin-6 inhibitors (3.1%).

After an average of 42 days of follow-up, the all-cause case mortality rate was 24.2%, the researchers report in the Journal of Thoracic Oncology.

Fast backward step-down selection was used to create a multivariable model with 73 different variables potentially linked with COVID-19 mortality. Seven variables were significantly associated with an increased likelihood of patient mortality: ECOG PS of 2 or more (odds ratio [OR]=2.47); neutrophil count above the upper limit of normal (ULN; OR=2.46); procalcitonin above the ULN (OR=2.37); stage IV disease (OR=1.96); diagnosis of pneumonia (OR=1.95); C-reactive protein above the ULN (OR=1.89); and age over 65 years (OR=1.71).

Receiver operating characteristic (ROC) curve analysis of these seven factors confirmed that this multivariable model had “good performance in estimating the outcome, with an [area under the ROC curve] of 0.78,” the researchers report. And this allowed the creation of a prognostic nomogram for the probability of death in thoracic malignancy patients with COVID-19.

Cortellini et al emphasize that their analysis “firmly established an ECOG PS ≥2 as the strongest determinant of mortality, suggesting clinicians should take it into consideration first when assessing patients, followed by neutrophil count and tumor stage in patients with a poor PS, and by serum CRP and procalcitonin in patients with a good PS.”

The researchers write that study weaknesses include “the relatively short observation period for each patient,” and that the cutoff date for the analysis means that only “a very small minority of patients would have received a SARS-CoV-2 vaccination before their infection.”

Nevertheless, they note that even with ongoing vaccinations, “SARS-CoV-2 will still impact the continuity of care of patients with cancer, given to the evolutionary nature of pandemics, vaccine hesitancy or [poor] access to it in low-income countries, and emerging new viral strains which may trigger immune-escape mechanisms.”

Cortellini and co-authors conclude: “Against this evolving scenario, a more tailored, comprehensive, and properly powered prognostication system like the one presented in this study will be a useful tool for clinicians as they develop oncology treatment plans for their patients.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

4 February 2022: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

J Thorac Oncol 2022; doi:0.1016/j.jtho.2021.12.015