Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. May 24, 2022; 13(5): 339-351
Published online May 24, 2022. doi: 10.5306/wjco.v13.i5.339
Co-relation of SARS-CoV-2 related 30-d mortality with HRCT score and RT-PCR Ct value-based viral load in patients with solid malignancy
Satya Narayan, Vineet Talwar, Varun Goel, Krushna Chaudhary, Anurag Sharma, Pallavi Redhu, Satyajeet Soni, Arpit Jain
Satya Narayan, Vineet Talwar, Varun Goel, Krushna Chaudhary, Pallavi Redhu, Satyajeet Soni, Arpit Jain, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi 110085, India
Anurag Sharma, Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi 110085, India
Author contributions: Narayan S and Talwar V were involved in design of study and the acquisition of data; Goel V, Chaudhary K, Redhu P, Soni S, Jain A were involved in the drafting and revision of the manuscript; Narayan S and Sharma A were involved in the statistical calculation; All authors discussed and contributed to the final manuscript.
Institutional review board statement: The study has been approved by our Institutional Review Board (RGCIRC/Res/SCM/46 2021/95) and was conducted according to the Declaration of Helsinki.
Conflict-of-interest statement: Authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Varun Goel, DNB, Doctor, Consultant Physician-Scientist, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5 Rohini, Sir Chhotu Ram Marg, New Delhi 110085, India. drvarungoyaloncologist@gmail.com
Received: October 3, 2021
Peer-review started: October 3, 2021
First decision: November 19, 2021
Revised: November 30, 2021
Accepted: April 25, 2022
Article in press: April 25, 2022
Published online: May 24, 2022
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) patients with malignancy are published worldwide but are lacking in data from India.

AIM

To characterize COVID-19 related mortality outcomes within 30 d of diagnosis with HRCT score and RT-PCR Ct value-based viral load in various solid malignancies.

METHODS

Patients included in this study were with an active or previous malignancy and with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the institute database. We collected data on demographic details, baseline clinical conditions, medications, cancer diagnosis, treatment and the COVID-19 disease course. The primary endpoint was the association between the mortality outcome and the potential prognostic variables, specially, HRCT score, RT-PCR Ct value-based viral load, etc. using logistic regression analyses treatment received in 30 d.

RESULTS

Out of 131 patients, 123 met inclusion criteria for our analysis. The median age was 57 years (interquartile range = 19-82) while 7 (5.7%) were aged 75 years or older. The most prevalent malignancies were of GUT origin 49 (39.8%), hepatopancreatobiliary (HPB) 40 (32.5%). 109 (88.6%) patients were on active anticancer treatment, 115 (93.5%) had active (measurable) cancer. At analysis on May 20, 2021, 26 (21.1%) patients had died. In logistic regression analysis, independent factors associated with an increased 30-d mortality were in patients with the symptomatic presentation. Chemotherapy in the last 4 wk, number of comorbidities (≥ 2 vs none: 3.43, 1.08-8.56). The univariate analysis showed that the risk of death was significantly associated with the HRCT score: for moderate (8-15) [odds ratio (OR): 3.44; 95% confidence interval (CI): 1.3-9.12; P = 0.0132], severe (> 15) (OR: 7.44; 95%CI: 1.58-35.1; P = 0.0112).

CONCLUSION

To the best of our knowledge, this is the first study from India reporting the association of HRCT score and RT-PCR Ct value-based 30-d mortality outcomes in SARS-CoV-2 infected cancer patients.

Keywords: SARS-CoV-2, COVID-19, Cancer, HRCT, Viral load

Core Tip: There is a higher fatality rate in cancer patients as compared to non-cancer patients. Also, a higher incidence of serious clinical events and intensive care unit (ICU) admissions in cancer patients. Analysis suggests patients have increased morbidity and mortality from recent cytotoxic chemotherapy. Patients with active untreated cancer, metastatic disease, progressive disease with multiple co-morbidity as well as getting palliative treatment are at a higher risk of mortality. Mortality rates are higher in patients with high baseline HRCT values at presentation and need longer ICU stays. Mortality rates are not a statistically significant co-relation with higher baseline RT-PCR based viral load values at presentation. Mortality rates are not higher in older cancer patients as compared to younger counterparts with cancer.