Clinical Characteristics of COVID-19 in Gynecological Cancer Patients during Chemotherapy-An Observational Study.

ABSTRACT

BACKGROUND: Infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects multiple organs throughout the body, which puts chemotherapy patients at even greater risk. This study aims to identify the clinical characteristics of gynecological cancer patients infected with SARS-CoV-2 during chemotherapy. METHODS: Gynecological cancer patients infected with SARS-CoV-2 during chemotherapy from August 1, 2022, to January 31, 2023, were enrolled in this observational cohort study. Patients in the control group were not infected with SARS-CoV-2. All continuous variables, including blood cells (leukocytes, neutrophils, lymphocytes) and biochemical indices (alanine transaminase (ALT), Aspartate transferase (AST), lactate dehydrogenase (LDH), albumin and creatinine) were repeatedly measured and analyzed statistically by the generalized additive mixed model (GAMM). Latent class analysis was estimated for the high-risk factors of severe COVID-19. The primary outcome was to develop a severe condition. RESULTS: During the study period, there were 71 patients with chemotherapy in our center. Of the 57 cases infected with SARS-CoV-2, 14 patients without infection, the infection rate was 80.28%. 52 cases out of the 57 infected patients were included in this study, 9.62% (5/52) cases showed severe disease, and 1 patient died. 51 cases survived during the acute coronavirus disease 2019 (COVID-19) phase. If chemotherapy is given after SARS-CoV-2 infection, tissues and organs that are sensitive to chemotherapy are more likely to be re-damaged by COVID-19. The plasma levels of leukocytes, neutrophils, lymphocytes, ALT, and AST decreased; LDH and creatinine in plasma showed a linear increase, while plasma albumin decreased, and platelets showed no apparent trend. The changes in blood cells and biochemical indices were most evident in relapsed patients and patients with COVID-19 within 2 weeks after chemotherapy. Latent class analysis showed that all severe COVID-19 patients were classified into class 1; the patients of class 1 showed a shorter interval between chemotherapy and COVID-19, and the higher baseline of AST, ALT, and LDH, the more cycles of chemotherapy and the advanced stage. CONCLUSIONS: The interval between chemotherapy and COVID-19 is associated with damage to tissues and organs. Clinical factors and laboratory factors indicate poor health conditions among patients with gynecological cancer and COVID-19.