A Definitive Prognostication System for Patients With Thoracic Malignancies Diagnosed With Coronavirus Disease 2019: An Update From the TERAVOLT Registry
Whisenant J.G. Baena J. Cortellini A. Huang L.-C. Lo Russo G. Porcu L. Wong S.K. Bestvina C.M. Hellmann M.D. Roca E. Rizvi H. Monnet I. Boudjemaa A. Rogado J. Pasello G. Leighl N.B. Arrieta O. Aujayeb A. Batra U. Azzam A.Y. Unk M. Azab M.A. Zhumagaliyeva A.N. Gomez-Martin C. Blaquier J.B. Geraedts E. Mountzios G. Serrano-Montero G. Reinmuth N. Coate L. Marmarelis M. Presley C.J. Hirsch F.R. Garrido P. Khan H. Baggi A. Mascaux C. Halmos B. Ceresoli G.L. Fidler M.J. Scotti V. Métivier A.-C. Falchero L. Felip E. Genova C. Mazieres J. Tapan U. Brahmer J. Bria E. Puri S. Popat S. Reckamp K.L. Morgillo F. Nadal E. Mazzoni F. Agustoni F. Bar J. Grosso F. Avrillon V. Patel J.D. Gomes F. Ibrahim E. Trama A. Bettini A.C. Barlesi F. Dingemans A.-M. Wakelee H. Peters S. Horn L. Garassino M.C. Torri V.
May 2022Elsevier Inc.
Journal of Thoracic Oncology
2022#17Issue 5661 - 674 pp.
Introduction: Patients with thoracic malignancies are at increased risk for mortality from coronavirus disease 2019 (COVID-19), and a large number of intertwined prognostic variables have been identified so far. Methods: Capitalizing data from the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry, a global study created with the aim of describing the impact of COVID-19 in patients with thoracic malignancies, we used a clustering approach, a fast-backward step-down selection procedure, and a tree-based model to screen and optimize a broad panel of demographics and clinical COVID-19 and cancer characteristics. Results: As of April 15, 2021, a total of 1491 consecutive eligible patients from 18 countries were included in the analysis. With a mean observation period of 42 days, 361 events were reported with an all-cause case fatality rate of 24.2%. The clustering procedure screened 73 covariates in 13 clusters. A further multivariable logistic regression for the association between clusters and death was performed, resulting in five clusters significantly associated with the outcome. The fast-backward step-down selection procedure then identified the following seven major determinants of death: Eastern Cooperative Oncology Group—performance status (ECOG-PS) (OR = 2.47, 1.87–3.26), neutrophil count (OR = 2.46, 1.76–3.44), serum procalcitonin (OR = 2.37, 1.64–3.43), development of pneumonia (OR = 1.95, 1.48–2.58), C-reactive protein (OR = 1.90, 1.43–2.51), tumor stage at COVID-19 diagnosis (OR = 1.97, 1.46–2.66), and age (OR = 1.71, 1.29–2.26). The receiver operating characteristic analysis for death of the selected model confirmed its diagnostic ability (area under the receiver operating curve = 0.78, 95% confidence interval: 0.75–0.81). The nomogram was able to classify the COVID-19 mortality in an interval ranging from 8% to 90%, and the tree-based model recognized ECOG-PS, neutrophil count, and c-reactive protein as the major determinants of prognosis. Conclusions: From 73 variables analyzed, seven major determinants of death have been identified. Poor ECOG-PS was found to have the strongest association with poor outcome from COVID-19. 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.
Cancer , COVID-19 , NSCLC , Registry , TERAVOLT , Thoracic
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Vanderbilt University Medical Center, Nashville, TN, United States
Hospital Universitario 12 de Octubre, Madrid, Spain
Department of Surgery and Cancer, Imperial College London, London, United Kingdom
Thoracic Oncology Unit, Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
Department of Medicine, University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, United States
Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Thoracic Oncology—Lung Unit, Ospedale Pederzoli, Peschiera d/G, Verona, Italy
Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
Seccion de Oncologia Medica, Hospital Universitario Infanta Leonor, Madrid, Spain
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
Division of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), México, México City, Mexico
Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
Faculty of Medicine, October 6 University, Giza, Egypt
Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
KasrAlAiny School of Medicine, Cairo University, El Cairo, Egypt
Semey Medical University, Center for Nuclear Medicine and Oncology of Semey, Semey, Kazakhstan
Thoracic Oncology Section, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
Groene Hart Ziekenhuis, The Netherlands, Gouda, Netherlands
Fourth Department of Medical Oncology and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece
Asklepios Kliniken GmbH, Asklepios Fachkliniken Muenchen, Gauting, Germany
Cancer Trials Ireland, Dublin, Ireland
Mid-Western Cancer Centre, University Hospital Limerick, Limerick, Ireland
Division of Hematology and Oncology, Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine Mount Sinai, New York, New York, United States
IRYCIS, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
Medical Oncology Unit, Department of Medical-Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia at ASST-Spedali Civili, Brescia, Italy
Service De Pneumologie, Hôpitaux Universitaires De Strasbourg, Strasbourg, France
Université De Strasbourg, Inserm UMR_S 1113, IRFAC, Laboratory Streinth (Stress REsponse and INnovative THerapy against Cancer), ITI InnoVec, Strasbourg, France
Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy
Department of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, Illinois, United States
Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
Department of Pneumology, Hôpital Foch, Suresnes, France
Service de Pneumologie et Cancérologie Thoracique, LHôpital Nord-Ouest, Villefranche S/S, France
Vall dHebron Institute of Oncology, Vall dHebron University Hospital, Barcelona, Spain
UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università degli Studi di Genova, Genoa, Italy
Toulouse University Hospital, Institut Universitaire du Cancer, Université Paul Sabatier, Toulouse, France
Section of Hematology and Medical Oncology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States
Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland, United States
Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Medical Oncology, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
Division of Medical Oncology, The Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States
Lung Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom
The Institute of Cancer Research, London, United Kingdom
Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States
Department of Precision Medicine, Medical Oncology and Haematology, Università degli studi della Campania L. Vanvitelli, Naples, Italy
Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO), LHospitalet de Llobregat, Barcelona, Spain
Medical Oncology, Careggi University Hospital, Florence, Italy
Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
Institute of Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Mesothelioma and Rare Cancer Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
Department of Medical Oncology, Centre Léon Bérard, Lyon, France
Division of Hematology and Oncology, Northwestern University, Chicago, Illinois, United States
Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, United Kingdom
The Clatterbridge Cancer Center NHS Foundation Trust, Birkenhead, United Kingdom
Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
Medical Oncology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
Gustave Roussy Institute, Villejuif, Aix Marseille University, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
Erasmus University Medical Center, Rotterdam, University Maastricht, The Netherlands, Maastricht, Netherlands
Stanford Cancer Institute, Stanford University, Stanford, California, United States
Lausanne University Hospital, Lausanne University, Lausanne, Switzerland
Vanderbilt University Medical Center
Hospital Universitario 12 de Octubre
Department of Surgery and Cancer
Thoracic Oncology Unit
Oncology Department
Department of Medicine
Thoracic Oncology Service
Thoracic Oncology—Lung Unit
Service de Pneumologie
Seccion de Oncologia Medica
Department of Surgery
Medical Oncology 2
Division of Medical Oncology/Hematology
Thoracic Oncology Unit
Respiratory Department
Department of Medical Oncology
Faculty of Medicine
Department of Medical Oncology
KasrAlAiny School of Medicine
Semey Medical University
Thoracic Oncology Section
Groene Hart Ziekenhuis
Fourth Department of Medical Oncology and Clinical Trials Unit
Asklepios Kliniken GmbH
Cancer Trials Ireland
Mid-Western Cancer Centre
Division of Hematology and Oncology
The Ohio State University Comprehensive Cancer Center
Center for Thoracic Oncology
IRYCIS
The Warren Alpert Medical School of Brown University
Medical Oncology Unit
Service De Pneumologie
Université De Strasbourg
Division of Oncology
Department of Medical Oncology
Department of Hematology
Department of Oncology
Department of Pneumology
Service de Pneumologie et Cancérologie Thoracique
Vall dHebron Institute of Oncology
UO Clinica di Oncologia Medica
Dipartimento di Medicina Interna e Specialità Mediche (DIMI)
Toulouse University Hospital
Section of Hematology and Medical Oncology
Johns Hopkins Kimmel Cancer Center
Comprehensive Cancer Center
Medical Oncology
Division of Medical Oncology
Lung Unit
The Institute of Cancer Research
Division of Medical Oncology
Department of Precision Medicine
Thoracic Oncology Unit
Medical Oncology
Medical Oncology
Institute of Oncology
Mesothelioma and Rare Cancer Unit
Department of Medical Oncology
Division of Hematology and Oncology
Medical Oncology Department
The Clatterbridge Cancer Center NHS Foundation Trust
Department of Research
Medical Oncology Department
Gustave Roussy Institute
Erasmus University Medical Center
Stanford Cancer Institute
Lausanne University Hospital
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