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A definitive prognostication system for patients with thoracic malignancies diagnosed with COVID-19: 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.
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Abstract
Background: Patients with thoracic malignancies are at increased risk for mortality from 4 Coronavirus disease 2019 (COVID-19) and large number of intertwined prognostic variables have 5 been identified so far. 6 Methods: Capitalizing data from the TERAVOLT registry, a global study created with the aim of 7 describing the impact of COVID-19 in patients with thoracic malignancies, we used a clustering 8 approach, a fast-backward step-down selection procedure and a tree-based model to screen and 9 optimize a broad panel of demographics, clinical COVID-19 and cancer characteristics. 10 Results: As of April 15, 2021, 1491 consecutive evaluable patients from 18 countries were 11 included in the analysis. With a mean observation period of 42 days, 361 events were reported 12 with an all-cause case fatality rate of 24.2%. The clustering procedure screened approximately 13 73 covariates in 13 clusters. A further multivariable logistic regression for the association between 14 clusters and death was performed, resulting in five clusters significantly associated with the 15 outcome. The fast-backward step-down selection then identified seven major determinants of 16 death ECOG-PS (OR 2.47 1.87-3.26), neutrophil count (OR 2.46 1.76-3.44), serum procalcitonin 17 (OR 2.37 1.64-3.43), development of pneumonia (OR 1.95 1.48-2.58), c-reactive protein (CRP) 18 (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 19 1.29-2.26). The ROC analysis for death of the selected model confirmed its diagnostic ability 20 (AUC 0.78; 95%CI: 0.75 – 0.81). The nomogram was able to classify the COVID-19 mortality in 21 an interval ranging from 8% to 90% and the tree-based model recognized ECOG-PS, neutrophil 22 count and CRP as the major determinants of prognosis. 23 Conclusion: From 73 variables analyzed, seven major determinants of death have been 24 identified. Poor ECOG-PS demonstrated the strongest association with poor outcome from 25 COVID-19. With our analysis we provide clinicians with a definitive prognostication system to help 26 determine the risk of mortality for patients with thoracic malignancies and COVID-19.
Authors
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.
Affiliation
Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, Tennessee, USA. Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain. Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, W12 0HS, London, UK;. Electronic address: a.cortellini@imperial.ac.uk. Thoracic Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20126 Milan, Italy. Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy Italy. Department of Medicine, University of Chicago; University of Chicago Comprehensive Cancer Center; 5841 S Maryland Ave, MC 2115, Chicago, IL, 60637-1654, USA. Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 885 2nd Ave., New York, NY 10017. 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 City, México. Respiratory Dept, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK. Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India. October 6 University Faculty of Medicine, 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. Fourth Department of Medical Oncology and Clinical Trials Unit Henry Dunant Hospital Center, Athens, Greece. Asklepios Kliniken GmbH, Asklepios Fachkliniken Muenchen, 82131 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, PA, USA. The Ohio State University Comprehensive Cancer Center, United States of America. Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine Mount Sinai, New York, New York, USA. IRYCIS, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. The Warren Alpert Medical School of Brown University, Providence, RI, USA. University of Brescia, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, ASST-Spedali Civili, Brescia, Lombardia, 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, 1300 Morris Park Ave, Bronx, NY 10461, United States. Department of Medical Oncology 1, Cliniche Humanitas Gavazzeni, Bergamo, Italy. Department of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA. Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy. Department of Pneumology, Hôpital Foch, 92150 Suresnes, France. Service de Pneumologie et Cancérologie Thoracique ; L'Hôpital Nord-Ouest, Villefranche S/S, France. Vall d'Hebron Institute of Oncology, Vall d'Hebron 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, Italy. Toulouse University Hospital, Institut Universitaire du Cancer, Université Paul Sabatier, Toulouse, France. Division of Hematology and Oncology, Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts. Johns Hopkins Kimmel Cancer Center, Baltimore, MD, USA. 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, USA. Lung Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom. Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA. 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), L'Hospitalet de Llobregat, 08908 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, 15121 Alessandria, Italy. Department of Medical Oncology, Centre Léon Bérard, Lyon, France. Division of Hematology/Oncology, Northwestern University, 676 N. St Clair, Suite 850, Chicago, IL 60611, USA. Medical Oncology department, The Christie NHS Foundation Trust, Manchester, UK. The Clatterbridge Cancer Center NHS Foundation Trust, Clatterbridge Rd, 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, CNRS, INSERM, CRCM, Marseille, France. Erasmus University Medical Center, Rotterdam, University Maastricht, Maastricht, The Netherlands. Stanford Cancer Institute, Stanford University, Stanford, California, USA. Lausanne University Hospital, Lausanne University, Lausanne, Switzerland.
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2022
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Whisenant JG, Baena J, Cortellini A, Huang L-C, Lo Russo G, Porcu L, et al. A definitive prognostication system for patients with thoracic malignancies diagnosed with COVID-19: an update from the TERAVOLT registry.. Journal of Thoracic Oncology. Elsevier BV; 2022.
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http://hdl.handle.net/10541/625055
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