Journal for ImmunoTherapy of Cancer (Mar 2021)
Systemic pro-inflammatory response identifies patients with cancer with adverse outcomes from SARS-CoV-2 infection: the OnCovid Inflammatory Score
- Joan Brunet,
- Josep Tabernero,
- Mieke Van Hemelrijck,
- Salvatore Grisanti,
- Bruno Vincenzi,
- Isabel Ruiz-Camps,
- Juan Aguilar-Company,
- Daniela Ferrante,
- Oriol Mirallas,
- Amanda Jackson,
- Beth Russell,
- Ramon Salazar,
- Aleix Prat,
- Daniele Generali,
- Nadia Harbeck,
- Alberto Zambelli,
- Carlo Alberto Tondini,
- David J Pinato,
- Lorenza Rimassa,
- Armando Santoro,
- Neha Chopra,
- Tom Newsom-Davis,
- Gino M Dettorre,
- Saoirse Dolly,
- Angela Loizidou,
- John Chester,
- Uma Mukherjee,
- Mark Bower,
- Christopher C T Sng,
- Alexia Bertuzzi,
- Ricard Mesia,
- Ailsa Sita-Lumsden,
- Elia Seguí,
- Federica Biello,
- Pavetha Seeva,
- Gianpiero Rizzo,
- Michela Libertini,
- Antonio Maconi,
- Charlotte Moss,
- Rossella Bertulli,
- Diego Ottaviani,
- Raquel Liñan,
- Andrea Marrari,
- M Carmen Carmona-García,
- Valeria Tovazzi,
- Vittoria Fotia,
- Claudia Andrea Cruz,
- Nadia Saoudi-Gonzalez,
- Eudald Felip,
- Ariadna Roqué,
- Alvin J X Lee,
- David García-Illescas,
- Roxana Reyes,
- Yien Ning Sophia Wong,
- Lorenza Scotti,
- Javier Marco-Hernández,
- Andrea Patriarca,
- Lorenzo Chiudinelli,
- Michela Franchi,
- Alessandra Gennari,
- Nikolaos Diamantis
Affiliations
- Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
- Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
- Mieke Van Hemelrijck
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
- Salvatore Grisanti
- Medical Oncology Unit, Spedali Civili, Brescia, Italy
- Bruno Vincenzi
- Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Isabel Ruiz-Camps
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
- Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
- Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Amanda Jackson
- Clinical Trials, Velindre Cancer Centre, Cardiff, UK
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain
- Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Cremona, Italy
- Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany
- Alberto Zambelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Carlo Alberto Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
- Tom Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
- Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
- Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
- Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
- Christopher C T Sng
- Cancer Division, University College London Hospitals, London, UK
- Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
- Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
- Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
- Pavetha Seeva
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
- Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Antonio Maconi
- Infrastruttura Ricerca Formazione Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Rossella Bertulli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
- Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
- Andrea Marrari
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- M Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
- Valeria Tovazzi
- Medical Oncology Unit, Spedali Civili, Brescia, Italy
- Vittoria Fotia
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Claudia Andrea Cruz
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Nadia Saoudi-Gonzalez
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
- Ariadna Roqué
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
- Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
- David García-Illescas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Roxana Reyes
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Yien Ning Sophia Wong
- Cancer Division, University College London Hospitals, London, UK
- Lorenza Scotti
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
- Javier Marco-Hernández
- Department of Internal Medicine, Hospital Clinic, Barcelona, Spain
- Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
- Lorenzo Chiudinelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Michela Franchi
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
- Nikolaos Diamantis
- Medical Oncology, Barts Health NHS Trust, London, UK
- DOI
- https://doi.org/10.1136/jitc-2020-002277
- Journal volume & issue
-
Vol. 9,
no. 3
Abstract
Background Patients with cancer are particularly susceptible to SARS-CoV-2 infection. The systemic inflammatory response is a pathogenic mechanism shared by cancer progression and COVID-19. We investigated systemic inflammation as a driver of severity and mortality from COVID-19, evaluating the prognostic role of commonly used inflammatory indices in SARS-CoV-2-infected patients with cancer accrued to the OnCovid study.Methods In a multicenter cohort of SARS-CoV-2-infected patients with cancer in Europe, we evaluated dynamic changes in neutrophil:lymphocyte ratio (NLR); platelet:lymphocyte ratio (PLR); Prognostic Nutritional Index (PNI), renamed the OnCovid Inflammatory Score (OIS); modified Glasgow Prognostic Score (mGPS); and Prognostic Index (PI) in relation to oncological and COVID-19 infection features, testing their prognostic potential in independent training (n=529) and validation (n=542) sets.Results We evaluated 1071 eligible patients, of which 625 (58.3%) were men, and 420 were patients with malignancy in advanced stage (39.2%), most commonly genitourinary (n=216, 20.2%). 844 (78.8%) had ≥1 comorbidity and 754 (70.4%) had ≥1 COVID-19 complication. NLR, OIS, and mGPS worsened at COVID-19 diagnosis compared with pre-COVID-19 measurement (p<0.01), recovering in survivors to pre-COVID-19 levels. Patients in poorer risk categories for each index except the PLR exhibited higher mortality rates (p<0.001) and shorter median overall survival in the training and validation sets (p<0.01). Multivariable analyses revealed the OIS to be most independently predictive of survival (validation set HR 2.48, 95% CI 1.47 to 4.20, p=0.001; adjusted concordance index score 0.611).Conclusions Systemic inflammation is a validated prognostic domain in SARS-CoV-2-infected patients with cancer and can be used as a bedside predictor of adverse outcome. Lymphocytopenia and hypoalbuminemia as computed by the OIS are independently predictive of severe COVID-19, supporting their use for risk stratification. Reversal of the COVID-19-induced proinflammatory state is a putative therapeutic strategy in patients with cancer.
