Mortality of COVID-19 pneumonia during anticancer treatment in lung cancer patients

Daliborka Bursać; Bojan Zarić; Darijo Bokan; Tomi  Kovačević; Vladimir Stojšić; Svetlana Petkov; Kosana Mitrović; Goran Stojanović

doi:10.2298/VSP211120018B

Daliborka Bursać University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Bojan Zarić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Darijo Bokan Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Tomi Kovačević University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Vladimir Stojšić University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Svetlana Petkov Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Kosana Mitrović Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Goran Stojanović Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia

DOI: https://doi.org/10.2298/VSP211120018B

Ključne reči: antineoplastici, komorbiditeti, covid-19; pluća, neoplazme, mortalitet, neoplazme, određivanje stadijuma

Sažetak

Uvod/Cilj. Pandemija coronavirus disease 2019 (COVID-19) ima višestruki uticaj na lečenje bolesnika obolelih od karcinoma. Lečenje malignih bolesti, uključujući hemioterapiju, ciljanu terapiju, imunoterapiju i radioterapiju može delovati supresivno na imunski sistem i dovesti do razvoja teških komplikacija COVID-19. Cilj ovog rada bio je da se utvrdi mortalitet bolesnika sa karcinomom bronha, kod kojih je prisustvo COVID-19 potvrđeno tokom aktivnog antitumorskog lečenja. Metode. Ova retrospektivna studija je sprovedena na Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici, Srbija. Kod svih bolesnika sa karcinomom bronha obuhvaćenih studijom, u toku aktivnog antitumorskog lečenja je potvrđeno prisustvo COVID-19, testiranjem nazofaringealnog brisa lančanom reakcijom polimeraze. Podaci o bolesnicima prikupljeni su korišćenjem institucionalne baze podataka za period od 20. novembra 2020. do 5. juna 2021. Statistička analiza podataka je urađena korišćenjem multivarijatnog i univarijatnog testiranja. Rezultati. Od ukupno 828 hospitalizovanih bolesnika sa COVID-19, bilo je 81 sa karcinomom bronha u toku aktivnog antitumorskog lečenja. Bolesnici, tačnije njih 55 (67,9%), bili su muškarci, pušači (55,6%), prosečnog životnog doba od 66,47 godina (u rasponu od 43–83 godine). Najveći broj bolesnika (50,6%) imao je the Eastern Cooperative Oncology Group Performance Status (ECOG PS) 1, a 83,9% je imalo najmanje jedan komorbiditet. Najčešći komorbiditeti bili su arterijska hipertenzija (66,7%), hronična opstruktivna bolest pluća - HOBP (28,4%) i dijabetes (21%), dok je gojaznost, kongestivnu srčanu insuficijenciju i druge kardiovaskularne bolesti imalo 11%, 6,2% i 7,4%, redom. Najčešći je bio adenokarcinom (33,3%), zatim skvamozni karcinom (30,9%) i mikrocelularni karcinom bronha (24,7%). Većina bolesnika (63%) bila je u stadijumu III, dok je 33,3% bolesnika bilo u stadijumu IV. Metastaze su najčešće bile prisutne u kontralateralnom plućnom krilu/pleuri (14,8%), mozgu (6,2%), a u kostima i jetri su bile prisutne jednako (3,7%). Samostalna sistemska terapija primenjena je kod 37 od 81 (45,6%) bolesnika, radioterapija grudnog koša kod 35 (43,2%), konkurentna hemioradioterapija kod jednog (1,2%) i drugi vidovi radioterapije kod 8 (9,87%) bolesnika. Najčešći oblici sistemske terapije bili su hemioterapija kod 29 od 81 (35,8%) bolesnika, imunoterapija kod 6 (7,4%) i ciljana terapija kod 2 (2,4%) bolesnika. Najčešće (34,6%) su primenjivani protokoli na bazi cisplatina. Ustanovljena stopa mortaliteta od COVID-19 iznosila je 19,8%, bez statistički značajne razlike u odnosu na vrstu lečenja (p = 0,973). Utvrđena je statistička značajnost uticaja ECOG PS na porast mortaliteta (p = 0,011). Zaključak. Bolesnici sa karcinomom bronha su zavisni od antitumorskog lečenja, ali su istovremeno populacija koja je osetljiva na COVID-19. U našem istraživanju nisu pronađene razlike u mortalitetu u odnosu na vrstu antitumorskog lečenja. Potrebna su dalja istraživanja kako bi se bolje razumeli efekti infekcije SARS-CoV-2 na bolesnike sa karcinomom. Takođe, potrebno je sprovesti sve moguće metode zaštite od infekcije SARS-CoV-2, kako bi se rizik od infekcije sveo na minimum kod svih osoba, a posebno kod imunokompromitovanih bolesnika sa karcinomom.

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Stopa mortaliteta od COVID-19 pneumonije u toku onkološkog lečenja bolesnika sa karcinomom bronha

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