Retrospective analysis of prognosis of tumor patients co-infected with COVID-19

doi:10.21203/rs.3.rs-2529295/v1

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Retrospective analysis of prognosis of tumor patients co-infected with COVID-19

https://doi.org/10.21203/rs.3.rs-2529295/v1

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Objective: To evaluate the effect of inflammatory factors produced by COVID-19 on the prognosis of tumor patients, and the effect of tumors with high expression of such inflammatory factors on the prognosis of COVID-19.

Methods: Combining the GEPIA database with R language software, we analyzed the effects of IL6, TNF, IL2RA and IL10 on the survival of 33 tumors types in the TCGA database. Then we analyzed the effects of inflammatory factors secreted by tumors on the progression and prognosis of COVID-19 using the data published jointly by nine hospitals in Wuhan.

Results: 1, The inflammatory factors IL6, TNF, IL2RA and IL10 produced by COVID-19 have different effects on the prognosis of different types of tumors. IL6 is more sensitive than TNF, IL2RA and IL10 in the assessment of tumor prognosis. 2, Tumors with high expression of IL6 are more likely to progress to severe high-risk case when infected with COVID-19 (severe COVID-19 rates 68.22%, P=0.042), with multiple organ severe damage, high mortality rates(23.36%, P=0.013) and poor prognosis. Tumor patients with high expression of TNF and IL10 also have higher mortality rates after infection with COVID-19 ,which were 23.60% (P= 0.027) and 23.28% (P = 0.007) respectively.

Conclusion: There is a sophisticated interaction between tumor and COVID-19, which IL6, TNF, IL2RA and IL10 produced by COVID-19 will affect the prognosis of tumors, while tumors with high expression of these inflammatory factors will also interfere with the prognosis of COVID-19. IL6 plays a more sensitive role in the evaluation of tumor prognosis of with COVID-19 and the prognosis of COVID-19 with tumor. Active use of IL6 antagonist therapy provides a new treatment idea for tumor patients co-infected with COVID-19.

Implications for Practice: This article supports that IL6 produced by COVID-19 has an effect on the prognosis of various tumors. At the same time, tumors with high expression of IL6 are more likely to progress to severe high-risk case when infected with COVID-19. Active use of IL6 antagonist therapy provides a new treatment idea for tumor patients co-infected with COVID-19.

inflammatory factors

prognosis of tumor

prognosis of COVID-19

In December 2019, the novel coronavirus disease 2019 (COVID-19) caused by the novel coronavirus (Severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) was first reported in Wuhan, China, and then quickly swept the country and the world. As of November 21, 2022, the cumulative number of confirmed cases of COVID-19 has exceeded 634 million, resulting in more than 6.59 million deaths [1]. The elderly are the susceptible population. Although most patients with COVID-19 have mild clinical symptoms, such as fatigue, cough, and fever, up to 20% of patients will progress to high-risk COVID-19 [2–3], manifesting as acute respiratory distress syndrome, and severe multiple organ failure. The mortality rate of high-risk COVID-19 is as high as 49-61.5%[4–5]. The cytokine release syndrome (CRS) generated by COVID-19 is one of the main reasons for the deterioration and death of COVID-19[3, 6 ]。

Compared with healthy people, the serum levels of not only Th1-type inflammatory factors (such as IL-1B, McP-1 and TNF) but also Th2-type inflammatory factors (such as IL9, IL10 and GM-CSF) in COVID-19 patients are significantly increased [7], which is an important feature that distinguishes CRS caused by SARS. Meanwhile, the serum concentrations of IL2RA, IL6 and TNF in COVID-19 patients are positively correlated with the rate of COVID-19 critical illness (i.e., the serum concentrations of corresponding inflammatory factors: critical patients > general patients, ICU patients > non-ICU patients) [3]. In addition, studies have shown that tumor patients are more susceptible to novel coronavirus and more likely to progress to severe high-risk COVID-19, and the serum levels of inflammatory factors mainly IL6, TNF, IL10 and IL2RA in such patients are significantly increased [8–9]. However, the impact of inflammatory factors produced by COVID-19 on the prognosis of patients with various types of tumors is rarely reported, and the impact of tumors with high expression of such inflammatory factors on the disease outcome of COVID-19 itself is also poorly studied. Therefore, this study intends to comprehensively analyze the TCGA database and the published retrospective clinical data of COVID-19 patients from 9 hospitals in Wuhan, China [9], to explore the correlation between the major inflammatory factors of COVID-19, such as IL6, TNF, IL10 and IL2RA, and the prognosis of patients with 33 kinds of tumors. And the impact of tumors with high expression of IL6, TNF, IL10 and IL2RA on the outcome of COVID-19.

1.1 Material

Based on the transcriptomic data and clinical information of 9661 cases of tumor tissues without COVID-19 infection collected from the TGCA database from the establishment of the database to August 6, 2020, including 77 cases of adrenal cortical carcinoma, 404 cases of bladder urothelial cell carcinoma, 1085 cases of breast invasive carcinoma, 306 cases of cervical cancer, 36 cases of gallbladder cancer, 275 cases of colon cancer, 47 cases of diffuse large B-cell lymphoma, 182 cases of esophageal cancer, 163 cases of glioma, 518 cases of head and neck squamous cell carcinoma, 66 cases of renal chromophobe cell carcinoma, 522 cases of renal clear cell carcinoma, 286 cases of renal papillary cell carcinoma, 173 cases of acute myeloid leukemia, 518 cases of low-grade brain glioma, 369 cases of hepatocellular carcinoma, 483 cases of lung adenocarcinoma, 486 cases of squamous cell carcinoma of the lung, 86 cases of mesothelioma, 426 cases of ovarian cancer, 179 cases of pancreatic cancer, 182 cases of pheochromocytoma and paraganglioma, 492 cases of prostate cancer, 92 cases of rectal cancer, 262 cases of sarcoma, 461 cases of cutaneous melanoma, 408 cases of gastric cancer, 137 cases of testicular germ cell tumor, 512 cases of thyroid cancer, 118 cases of thymic carcinoma, 174 cases of endometrial carcinoma, 57 cases of uterine sarcoma and 79 cases of uveal melanoma. The effects of IL6, TNF, IL2RA and IL10 in CRS caused by COVID-19 on the prognosis of patients with above tumors were analyzed.

Using the clinical data and laboratory test results of 232 patients with confirmed tumor diagnosis and co-infected with COVID-19 collected from 9 hospitals including Wuhan Tongji Hospital, Union Hospital and Wuhan First Hospital in China from January 13 to March 18, 2020 [9], namely 33 cases of bladder cancer, 31 cases of breast cancer, 27 cases of colorectal cancer, 25 cases of thyroid cancer, 23 cases of lung cancer, 18 cases of gastric cancer, 11 cases of cervical cancer, 8 cases of liver cancer, and 8 cases of prostate cancer, 6 cases of esophageal cancer and 42 other cases, to analyze the effect of tumor-expressed inflammatory factors on the outcome of COVID-19.

1.2 Methods

TCGA Visualization data platform GEPIA[10] (Gene Expression Profiling Interactive Analysis, http://gepia.cancer-pku.cn) is an interactive web server of cancer expression profile data developed by Peking University. It contains the RNA sequencing expression data and corresponding clinical information of 33 kinds of cancer tissues from TCGA database and 32 kinds of normal tissues from GTEx database. Gene expression and its correlation with prognosis of cancer patients can be analyzed online. Select the Survival Plots, enter IL6, TNF, IL2RA, and IL10 in Gene, and then select each cancer type in Datasets Selection, setting 95% confidence intervals. The median expression of IL6, TNF, IL2RA and IL10 in each cancer species was used as the boundary for survival analysis to evaluate the impact of inflammatory factors produced by COVID-19 on the prognosis of cancer patients.

Based on the data of COVID-19 retrospective clinical studies jointly published by 9 hospitals in Wuhan, China, cancer types with no less than 6 co-infected cases of COVID-19 were selected, namely bladder cancer, breast cancer, colorectal cancer, thyroid cancer, lung cancer, gastric cancer, cervical cancer, liver cancer, prostate cancer and esophageal cancer. According to the median mRNA expression of IL6, TNF, IL2RA and IL10 in the 10 types of cancer, TCGA data and tumor patients co-infected with COVID-19 were divided into high and low expression groups, that is, The tumor tissues with low expression of IL6 included liver cancer, thyroid cancer, breast cancer, prostate cancer and cervical cancer. while the IL6 high expression group included colorectal cancer, bladder cancer, esophageal cancer, gastric cancer and lung cancer. The tumor tissues with low expression of TNF included liver cancer, prostate cancer, thyroid cancer, bladder cancer and colorectal cancer, while the TNF high expression group included gastric cancer, esophageal cancer, lung cancer, breast cancer and cervical cancer. The IL2RA low expression group included liver cancer, prostate cancer, thyroid cancer, breast cancer and bladder cancer, while the IL2RA high expression group included cervical cancer, colorectal cancer, esophageal cancer, gastric cancer and lung cancer. The IL10 low expression group included liver cancer, prostate cancer, thyroid cancer, colorectal cancer and esophageal cancer, while the IL10 high expression group included bladder cancer, gastric cancer, cervical cancer, breast cancer and lung cancer. Using the Graphpad Prism8.0 analysis software, select the "Grouped" option to create a new stacked graph, and analyze the effect of tumors with high expression of IL6, TNF, IL2RA and IL10 on the outcome of co-infection with COVID-19 by chi-square test.

TIMER2.0 (Tumor Immune Estimation Resource [11–13], http://timer.cistrome.org) is a comprehensive analysis of the Tumor and Immune cell interactions data platform, It covers the information of 32 Cancer species in TCGA database except acute myeloid leukemia and consists of three major online analysis modules: Immune Association, Cancer Exploration and Immune Estimation. Select the "Gene" module in the "Immune Association" section, enter IL6 in "Gene Expression" after entering the page, Then, six kinds of common intratumor infiltrating Immune cells, CD4 + T, CD8 + T, B cells, neutrophils, macrophages, and dendritic cells, were selected respectively at "Immune Infiltrates". After clicking "Submit", the platform automatically calculated and generated the Pearson correlation between IL6 and immune cell infiltration in each tumor tissue.

1.3 Statistical methods

Statistical analysis was performed using Graphpad Prism 8.0 and R4.0.0 software. Measurement data were expressed as mean ± standard deviation, using t test; Enumeration data were expressed as percentage (%), using chi-square test; Kaplan-Meier method was used to draw survival curve, log-rank test was used; Pearson correlation coefficient was used for IL6 Correlation analysis with immune cell infiltration; P < 0.05 was considered statistically significant.

2.1 Inflammatory factors produced by COVID-19 may be related to tumor prognosis

Based on the TCGA database, the relationship between IL6, TNF, IL2RA and IL10 and the prognosis of tumor patients with 33 types of cancer was analyzed, with P < 0.05 as the statistical screening standard. The results showed that high expression of IL6 in tumor tissue was negatively correlated with the prognosis of eight tumor patients, such as cervical cancer (HR = 1.7, P = 0.026), head and neck squamous cell carcinoma (HR = 1.3, P = 0.029), renal clear cell carcinoma (HR = 1.9, P < 0.001), renal Papillary cell carcinoma (HR = 2.5, P = 0.008), brain low-grade glioma (HR = 1.9, P < 0.001), pancreatic cancer (HR = 1.5, P = 0.049), gastric cancer (HR = 1.5, P = 0.010) and uveal melanoma (HR = 2.6, P = 0.038), but positively correlated with the prognosis of sarcoma patients (HR = 0.58, P = 0.008) (Fig. 1). The high expression of TNF in tumor tissues was negatively correlated with the prognosis of thymic carcinoma (HR = 14.0, P = 0.016), and positively correlated with the prognosis of sarcoma (HR = 0.55, P = 0.006) and cutaneous melanoma (HR = 0.67, P = 0.004) (Fig. 2A-D). High expression of IL2RA in tumor tissue was negatively associated with prognosis in patients with acute myeloid leukemia (HR = 3.3, P < 0.001) and lung squamous cell carcinoma (HR = 1.4, P = 0.028), but positively correlated with the prognosis of patients with cutaneous melanoma (HR = 0.51, P < 0.001) (Fig. 2E-H).The high expression of IL10 in tumor tissues was negatively correlated with the prognosis of patients with acute myeloid leukemia (HR = 2.6, P = 0.001), low-grade glioma (HR = 1.6, P = 0.009), thymic carcinoma (HR = 9.0, P = 0.04) and uveal melanoma (HR = 2.8, P = 0.032). However, it was positively correlated with the prognosis of patients with head and neck squamous cell carcinoma (HR = 0.75, P = 0.04) and cutaneous melanoma (HR = 0.61, P < 0.001) (Fig. 2I-O).

Based on the above factors on the prognosis of patients with tumor of inflammation, it is suggested that co-infection COVID − 19 may promote the development of the 10 kinds of tumors, such as cervical cancer, renal clear cell carcinoma, renal papillary carcinoma, brain low grade gliomas, pancreatic cancer, stomach cancer, uveal melanoma, thymic carcinoma, acute myeloid leukemia and lung squamous cell carcinoma, but alleviate the progression of sarcomas and cutaneous melanoma. In addition, different inflammatory factors have different effects on the prognosis of different tumor types, indicating that CRS produced by COVID-19 has tumor type-specific effects on the prognosis of cancer patients. At the same time, compared with TNF, IL2RA and IL10, IL6 can affect the prognosis of patients with more cancer types, suggesting that elevated IL6 in CRS caused by COVID-19 has a more sensitive predictive value for tumor prognosis.

2.2 Correlation between inflammatory factors expressed in tumors and the prognosis of COVID-19:

The above studies indicate that inflammatory factors produced by COVID-19 may have a certain impact on the prognosis of cancer patients, and whether inflammatory factors produced by tumors may also affect the disease outcome of COVID-19 has rarely been reported. In order to further explore the impact of tumor expression of IL6, TNF, IL2RA and IL10 on the outcome of COVID-19, we divided tumor types into two groups based on TCGA database platform: high expression of inflammatory factors in tumor tissue and low expression of inflammatory factors in tumor tissue (see Methods for details), and P < 0.05 was used as the statistical screening criterion. The mRNA level of low expression group vs high expression group was as follows: 1) IL6:1.28 ± 0.623 vs 3.95 ± 1.85, P = 0.015; 2) TNF: 0.36 ± 0.21 vs 0.99 ± 0.23, P = 0.002; 3) IL2RA: 0.72 ± 0.42 vs 2.07 ± 0.77, P = 0.009; 4) IL10:0.30 ± 0.14 vs 0.66 ± 0.10, P = 0.002 (Fig. 3A-D). When co-infected with COVID-19, the levels of corresponding inflammatory factors in the serum of the cancer species group with high expression of IL6 and TNF were also significantly up-regulated (Fig. 3E-F). The serum levels of the low expression group versus the high expression group were: 1) IL6:9.00 ± 8.20 vs. 17.46 ± 4.17(pg/ml), P < 0.001; 2) TNF: 7.87 ± 1.12 vs 9.52 ± 2.66(pg/ml), P < 0.001. However, the IL2RA level in the cancer group with high IL2RA expression was decreased (Fig. 3G, serum level of the low expression group vs the high expression group: 676.71 ± 263.69 vs 561.15 ± 174.80(U/ml), P < 0.001). There was no significant difference in serum IL10 levels in cancer species with high IL10 expression (Fig. 3H). Cancer species with high expression of IL6 and TNF in both serum and tumor tissues had significantly increased mortality due to COVID-19 (Fig. 3M-N), which was 9.64% vs 23.36%, P = 0.013 and 11.88% vs 23.60%, P = 0.027, respectively, compared with the low expression group. Only the cancer species with high IL10 expression in tumor tissues also had a significantly higher mortality rate due to COVID-19 (Fig. 3P), compared with the low expression group: 8.11% vs 23.28%, P = 0.07. However, the cancer group with high expression of IL2RA only in tissues and down-regulation of IL2RA in serum after co-infection with COVID-19 was not statistically associated with mortality due to COVID-19 (Fig. 3O). Among them, the cancer species group with only high expression of IL6 was positively correlated with the incidence of severe high-risk COVID-19 (Fig. 3I, the severe rate of low expression group vs high expression group: 54.22% vs 68.22%, P = 0.042), while TNF, IL10 and IL2RA were not statistically correlated with the mild-severe COVID-19 classification (Fig. 3J-L). These results further support that IL6 plays a more important role in the prognosis of tumor patients co-infected with COVID-19 and in the assessment of COVID-19 outcome.

2.3 Progression of COVID-19 in tumor patients with high IL6 expression

To further explore the effect of IL6 on the progression of COVID-19 in cancer patients, we emphatically analyzed the changes of laboratory inflammation indicators and multiple organ injury indicators in cancer patients with COVID-19 (Table 1). There were no significant differences in age, tumor stage, tumor differentiation, admission symptoms, CT findings and history of other chronic diseases between the two groups of patients with high and low expression of IL6 in tumor tissue (except for diabetes, P = 0.031). However, compared with the IL6-low-expressing cancer group, in the IL6-high-expressing cancer group, the acute phase reactive proteins procalcitonin, ferritin, and C-reactive protein were significantly increased; CD4 + T cells and NK cells decreased most significantly, and the proportion of CD8 + T cells increased relatively. At the same time, multiple organ damage was severe, manifested as alanine aminotransferase, creatinine, N-terminal brain natriuretic peptide precursor, high-sensitivity cardiac troponin I, Globulin, total protein, and neutrophil ratios increased significantly, while albumin, albumin/globulin ratio, total bilirubin, direct bilirubin, estimated glomerular filtration rate, the proportions of the mononuclear cells and eosinophilic cells significantly lower; Coagulation function was also disrupted, prothrombin time and activated partial thromboplastin time were prolonged, thrombin activity was decreased, thrombin time was shortened, fibrinogen content was up-regulated, blood cells and hemoglobin content were also significantly decreased (all P < 0.05). At the same time, with the increase of IL6 expression in tumor tissues, the mortality rate caused by COVID-19 also showed an upward trend. For example, lung cancer and gastric cancer with the highest IL6 expression had the highest mortality rate (39% and 28%, respectively), while liver cancer with the lowest IL6 expression had no COVID-19 mortality rate (Fig. 4).

Since it was first reported, COVID-19 has rapidly escalated into a public health emergency of international concern, becoming a serious threat to life and health. Unlike SARS and MERS, the two previous coronaviruses that cause severe respiratory diseases, COVID-19 caused by novel coronavirus are more due to severe damage of multiple organs rather than acute respiratory distress syndrome [14], among which CRS is one of the main causes. Our study inferred the influence of cytokines produced by tumor tissue on the outcome of COVID-19 disease by focusing on inflammatory factors mainly IL6, TNF, IL10 and IL2RA. Only the cancer group with high expression of IL6 in tumor tissues was positively correlated with the severe and mortality rate of COVID-19, and multiple organs were severely injured. The expression level of IL6 in serum was also significantly up-regulated after co-infection with COVID-19, which is expected to be a sensitive and non-invasive indicator for evaluating the outcome of COVID-19 in cancer patients. Although the cancer group with high expression of TNF and IL10 in tumor tissues was not statistically correlated with the severe COVID-19 rate, it was positively correlated with the mortality caused by COVID-19. The serum TNF content was also significantly upregulated after co-infection with COVID-19, while the serum IL10 level was unchanged. These results suggest that TNF can be used as a second noninvasive indicator to assist IL6 in improving the efficiency of evaluating the outcome of COVID-19.

Previous studies have shown that the elderly and patients with underlying diseases, such as diabetes, hypertension, cardiovascular diseases [4, 15–16] and cancer patients [8–9], are susceptible to COVID-19. In this study, we also found that the cancer group with high IL6 expression was more often accompanied by a history of diabetes than the cancer group with low IL6 expression (Table 1, P < 0.031). There was no statistical difference in age, which may be related to the ageing of the tumor itself (Table 1, age of IL6 low expression group vs high expression group: 63.37 ± 2.20 vs 63.65 ± 2.97 (years)). The study of Professor Ren Shancheng et al. showed that COVID-19 has gender bias, male cancer patients are more likely to be co-infected with COVID-19 than female cancer patients, and the severe COVID-19 rate and mortality are also higher [17]. In our study, the cancer species group with high IL6 expression was also dominated by men (Table 1, P < 0.001), suggesting that patients with IL6 high expression tumors (such as lung, gastric, esophageal, bladder and colorectal cancer patients) were susceptible and at high risk of COVID-19.

Unlike other underlying diseases, the number of patients with co-infected COVID-19 tumors was limited, which prevented prospective exploration in the short term, and different tumors were highly heterogeneous, so we evaluated them separately according to tumor type. In this study, the effects of IL6, TNF, IL10 and IL2RA on the prognosis of patients with various tumors were analyzed based on the data of 33 tumors in TCGA database, so as to explore the profound impact of CRS caused by COVID-19 on the prognosis of patients with various tumors. Then, the impact of tumors with high expression of IL6, TNF, IL10 and IL2RA on the prognosis of COVID-19 was explored by mining the published retrospective clinical data of COVID-19 [9]. The results suggest that IL6 plays a central role in the prognosis of cancer patients and the outcome of COVID-19. However, due to the limited number of tumor patients co-infected with COVID-19, it is difficult to conduct prospective population verification. In the future, in-depth analysis and verification are still needed based on larger population data.

In addition to CRS, a decrease in the total number of peripheral blood lymphocytes is another important feature of COVID-19 [18–19], especially in the early stage of COVID-19. However, there is still no study on whether the decrease in the total number of peripheral blood lymphocytes caused by COVID-19 affects the infiltration of lymphocytes in tumor tissues and becomes a prognostic factor of cancer patients. In this study, we found that compared with the cancer group with low IL6 expression in tumor tissues, the total amount of peripheral blood lymphocytes in the cancer group with high IL6 expression in tumor tissues decreased, especially B cells, CD4 + T cells and NK cells. The proportion of CD8 + T cells increased relatively, while the proportion of monocytes and eosinophils decreased, and the percentage of neutrophils was relatively increased. TIMER2.0 was used to evaluate tumor-infiltrating immune cells in TCGA database, and we found that IL6 expression was correlated with tumor-infiltrating immune cells (Figure. 5B). For example, IL6 expression was positively correlated with dendritic cells, macrophages, neutrophils and CD8 + T cells, but negatively correlated with B cells and CD4 + T cells. It was consistent with the changes of B cells, CD4 + T cells, CD8 + T cells and neutrophils in peripheral blood. In addition, we evaluated the effect of infiltrating immune cells on the prognosis of tumor patients and found that the effect of different immune cells on the prognosis of tumor patients also showed tumor type heterogeneity (Figure. 5A), suggesting that the effect of IL6 on the prognosis of tumor patients may be partly achieved by regulating the flow between peripheral blood and infiltrating immune cells in the tumor. However, as there is no direct evidence to show the correlation between the changes of peripheral blood immune cells and tumor infiltrating immune cells, this study only provides a reference idea.

In the face of the global spread and threat of COVID-19, there has been no unified opinion on the care and treatment of cancer patients, especially those co-infected with COVID-19 [20–23]. This study suggests that patients with lung cancer, gastric cancer, esophageal cancer, bladder cancer and colorectal cancer who have high expression of IL6 should be actively treated with IL6 antagonists when co-infected with COVID-19, which can reduce the dual role of IL6 on the outcome of COVID-19 and the prognosis of cancer patients, and provide a new treatment idea for cancer patients co-infected with COVID-19. In addition, in addition to actively adopting individualized and precise protocols for patients with different types of tumors co-infected with COVID-19, this study also suggests that patients without COVID-19 should actively carry out publicity and education to improve their self-protection measures and awareness of COVID-19.

ACC Adrenocortical carcinoma

BLCA Bladder Urothelial Carcinoma

BRCA Breast invasive carcinoma

CESC Cervical squamous cell carcinoma and endocervical adenocarcinoma

CHOL Cholangio carcinoma

COAD Colon adenocarcinoma

DLBC Lymphoid Neoplasm Diffuse Large B-cell Lymphoma

ESCA Esophageal carcinoma

GBM Glioblastoma multiforme

HNSC Head and Neck squamous cell carcinoma

KICH Kidney Chromophobe

KIRC Kidney renal clear cell carcinoma

KIRP Kidney renal papillary cell carcinoma

LAML Acute Myeloid Leukemia

LGG Brain Lower Grade Glioma

LIHC Liver hepatocellular carcinoma

LUAD Lung adenocarcinoma

LUSC Lung squamous cell carcinoma

MESO Mesothelioma

OV Ovarian serous cystadenocarcinoma

PAAD Pancreatic adenocarcinoma

PCPG Pheochromocytoma and Paraganglioma

PRAD Prostate adenocarcinoma

READ Rectum adenocarcinoma

SARC Sarcoma

SKCM Skin Cutaneous Melanoma

STAD Stomach adenocarcinoma

TGCT Testicular Germ Cell Tumors

THCA Thyroid carcinoma

THYM Thymoma

UCEC Uterine Corpus Endometrial Carcinoma

UCS Uterine Carcinosarcoma

UVM Uveal Melanoma

Funding

This work was supported by National Natural Science Foundation of China [Grant No 82003264, 51972343 and 51937011]; Friendship Seed Program [YYZZ202019]

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Disclosure statement

Authors have no conflict of interest to declare.

Authors’ contributions

X.M and J.M designed the research, X.M and B.Y performed the research, analyzed the data and wrote the manuscript. X.M and B.Y analyzed the data. All authors contributed to the article and approved the submitted version.

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No competing interests reported.

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Table 1: Effect of IL6 expression in tumor tissue on laboratory tests and disease outcome of COVID-19.

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Retrospective analysis of prognosis of tumor patients co-infected with COVID-19

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Abstract

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Introduction

Materials And Methods

1.1 Material

1.2 Methods

Results

2.2 Correlation between inflammatory factors expressed in tumors and the prognosis of COVID-19:

2.3 Progression of COVID-19 in tumor patients with high IL6 expression

Discussion

Abbreviations

Declarations

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