Immunological alternation in COVID-19 patients with cancer and its implications on mortality

Oncoimmunology. 2021 Jan 4;10(1):1854424. doi: 10.1080/2162402X.2020.1854424.

Abstract

Patients with malignancy were reportedly more susceptible and vulnerable to Coronavirus Disease 2019 (COVID-19), and witnessed a greater mortality risk in COVID-19 infection than noncancerous patients. But the role of immune dysregulation of malignant patients on poor prognosis of COVID-19 has remained insufficiently investigated. Here we conducted a retrospective cohort study that included 2,052 patients hospitalized with COVID-19 (Cancer, n = 93; Non-cancer, n = 1,959), and compared the immunological characteristics of both cohorts. We used stratification analysis, multivariate regressions, and propensity-score matching to evaluate the effect of immunological indices. In result, COVID-19 patients with cancer had ongoing and significantly elevated inflammatory factors and cytokines (high-sensitivity C-reactive protein, procalcitonin, interleukin (IL)-2 receptor, IL-6, IL-8), as well as decreased immune cells (CD8 + T cells, CD4 + T cells, B cells, NK cells, Th and Ts cells) than those without cancer. The mortality rate was significantly higher in cancer cohort (24.7%) than non-cancer cohort (10.8%). By stratification analysis, COVID-19 patients with immune dysregulation had poorer prognosis than those with the relatively normal immune system both in cancer and non-cancer cohort. By logistic regression, Cox regression, and propensity-score matching, we found that prior to adjustment for immunological indices, cancer history was associated with an increased mortality risk of COVID-19 (p < .05); after adjustment for immunological indices, cancer history was no longer an independent risk factor for poor prognosis of COVID-19 (p > .30). In conclusion, COVID-19 patients with cancer had more severely dysregulated immune responses than noncancerous patients, which might account for their poorer prognosis. Clinical Trial: This study has been registered on the Chinese Clinical Trial Registry (No. ChiCTR2000032161).

Keywords: COVID-19; SARS-CoV-2; cancer; immune response; mortality; prognosis.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • COVID-19 / diagnosis
  • COVID-19 / immunology
  • COVID-19 / mortality*
  • COVID-19 / virology
  • Case-Control Studies
  • China / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / immunology*
  • Neoplasms / mortality
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / immunology*
  • SARS-CoV-2 / isolation & purification
  • Severity of Illness Index

Grants and funding

The study was supported by the National Science and Technology Major Sub-Project [2018ZX10301402-002], the Technical Innovation Special Project of Hubei Province [2018ACA138], the National Natural Science Foundation of China [81772787, 81873452, and 81974405], and the Fundamental Research Funds for the Central Universities [2019kfyXMBZ024]. The sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author (Q-L G) had full access to all data in the study and final responsibility for the study.