Site of Cancer Metastasis May Impact COVID-19 Outcomes

Cancer patients with metastasis are more likely to have poor outcomes of COVID-19, and the site of metastasis impacts outcomes, according to research published in Cancer.

Researchers found that patients with metastatic cancer were more likely than those without metastasis to be hospitalized for COVID‐19, require supplemental oxygen, and die after developing COVID-19.

Patients with brain metastasis had a particularly high risk of severe COVID-19, and patients with lung metastasis had a high risk of death within 30 days of COVID-19 diagnosis.

Researchers conducted this study using data from 10,065 patients enrolled in the COVID-19 and Cancer Consortium registry (ClinicalTrials.gov Identifier: NCT04354701) between March 17, 2020, and March 31, 2022.

All patients had cancer and COVID-19. A total of 2325 patients had metastatic cancer at COVID-19 diagnosis. The most common site of metastasis was bone (n=837), followed by lung (n=716), liver (n=605), lymph nodes (n=578), and brain (n=284). There were 1033 patients with multiple sites of metastasis.

Patients with metastasis were younger than patients without metastasis (median age, 63 years and 65 years, respectively). Patients with metastasis were also less likely to be in remission (<1% vs 71%) and more likely to be immunosuppressed (46% vs 20%).

Patients with metastatic cancer were more likely to be hospitalized for COVID‐19, to require supplemental oxygen, and to die at any time point. However, a similar proportion of patients in each group were admitted to the intensive care unit (ICU) and received mechanical ventilation. Outcomes in patients with and without metastasis can be seen in the table below.

COVID-19 Outcomes by Metastatic Status and Site
Outcome	No Metastasis	Any Metastasis	Bone  Metastasis	Lung  Metastasis	Liver  Metastasis	Lymph Node  Metastasis	Brain  Metastasis
Hospitalized	49%	59%	60%	58%	61%	56%	65%
Received Oxygen	34%	38%	41%	34%	41%	36%	42%
Admitted to ICU	14%	14%	14%	14%	16%	12%	20%
Received Mechanical Ventilation	8%	8%	8%	8%	10%	8%	8%
Died at Any Time	13%	29%	30%	33%	33%	26%	39%
Died Within 30 days	9%	18%	19%	19%	21%	16%	24%
Died Within 90 days	16%	34%	34%	37%	40%	30%	49%
Died Within 180 days	23%	48%	48%	54%	54%	43%	61%

When the researchers adjusted for age, sex, smoking status, comorbidities, cancer status, and therapy, patients with metastatic cancer were more likely to have severe COVID-19 (adjusted odds ratio [aOR], 1.76; 95% CI, 1.53-2.03) and more likely to die within 30 days of COVID-19 diagnosis (aOR, 1.54; 95% CI, 1.21-1.95).

Patients with brain metastasis had the highest risk of severe COVID‐19 (aOR, 2.21; 95% CI, 1.68-2.91), but patients with lung metastasis had the highest risk of dying within 30 days of COVID-19 diagnosis (aOR, 1.53; 95% CI, 1.17-2.00).

“Identifying a population at increased risk for complications from COVID‐19 underscores the necessity of ensuring that these patients receive appropriate vaccinations and early COVID‐19 treatments,” the researchers wrote. “Patients with metastatic cancer, and especially those with lung metastases, should be appropriately represented in studies of COVID‐19 treatments and preventative strategies.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Cancer Therapy Advisor