Cancer Associates with Risk and Severe Events of COVID-19: A Systematic Review and Meta-Analysis

Background: There have been inconsistent reports with a small size of study that patients of cancer are likely associated with the development of COVID-19 after infection with the severe acute respiratory syndrome coronavirus-2. A robust estimate is needed urgently to convey appropriate information to the society and the public, in the time of ongoing pandemic of COVID-19. Methods: We performed a systematic review and meta-analysis through a systematic literature search on PubMed, Elsevier and Web of Science, additionally on three major databases of CNKI, WangFang, and VIP in Chinese. Selection of publications and data extraction were performed by two investigators independently, according to the predefined criteria of inclusion and exclusion. A meta-analysis was carried out to obtain the estimates of pooled prevalence of cancer in patients with COVID-19 and estimate the odds ratio for the association of cancer with severe events, using fixedeffect or random-effect model when there was significant heterogeneity between studies; subgroup analysis was also conducted by some characteristics of the samples. Potential publication bias was assessed using Begg’s and Egger’s test and corrected using the “trim and fill” method when necessary. Findings: A total of 38 studies met the criteria for meta-analysis, comprising 7,094 patients with COVID-9. The pooled prevalence of cancer in patients with COVID-19 was estimated with random-effect model at 2.3% (I2=52.6%, 95 %CL [0.018, 0.029]; p<0.001) overall and 3.2% (I2=59.3%; 95%CL [0.023-0.041]; p<0.001) in Hubei province, and the corresponding estimates were 1.4% and 1.9% after corrections for publication bias, respectively. Cancer was significantly associated with severe cases (Odd ratio[OR]=2.20, 95%CL [1.53, 3.17]; p<0.001) and death (OR=2.97, 95%CL [1.48, 5.96]; p=0.002) in patients with COVID-19, no significant heterogeneity between studies and a minimal publication bias according to the Begg’s and Egger’s test. Interpretation: We conclude that cancer is associated with the risk and severe events of COVID-19. Special measures should be taken to preventing individuals with cancer from infection and managing the patients of cancer with COVID-19. Funding Statement: The study supported by the Key Research Project of Beijing University of Chinese Medicine (2020-JYB-ZDGG-143-1), National Natural Science Foundation of China (81573736) and Beijing Haiju Scholarship (BHTO201511097). Declaration of Interests: All authors declare no conflicts of interest.