In cancer cases, COVID-19 morbidity and mortality are higher than the normal population (11,12). Therefore, various studies have been conducted to determine the factors that can predict mortality. Our study aimed to investigate the factors affecting survival in gastrointestinal cancer patients with COVID-19 disease. In addition, we aimed to examine the effects of various inflammatory parameters on survival, which may be an indicator of the hyper-inflammatory state caused by COVID-19 in patients with genitourinary cancer.
Hyper-inflammatory state during COVID-19 in cancer patients is one of the main reasons that increase mortality. The negative acute-phase reaction, driven by interleukin 6 and other cytokines; causes lymphocytopenia, hypoalbuminemia, and cytokine excess (13–15). Systemic
inflammation destroys CD4 + T lymphocytes and increases suppressor CD8 + T lymphocytes, thus leading to an increase in neutrophil-lymphocyte ratio. A recent study found that neutrophil-lymphocyte ratio, on Covid Inflammatory Score, prognostic index, prognostic index, modified Glasgow prognostic score were associated with survival (10). In our study, however, no statistically significant relationship was found between inflammatory parameters and survival. This result may be due to our study’s small number of patients. In addition, while the other study included all cancer types, our study only included patients with genitourinary cancer. This may have changed the results.
Cancer patients are immunosuppressed due to malignancy and anti-tumor therapy. Therefore they have a predisposition for respiratory diseases and severe pneumonia. The need for mechanical ventilation may therefore be associated with prognosis. In a previous study, a statically significant relationship was found between the need for mechanical ventilation and mortality (15,16). In our study, a significant relationship was found in the univariate analysis (p = 0.05). Multivariate analysis by Cox proportional hazard model showed that mechanical ventilation requirement was considered an independent prognostic factor for survival. While other studies included general cancer groups, only patients with genitourinary cancer were included in our study (15,16). The relationship between mechanical ventilation and survival may also vary in cancer subgroups. There are very few studies in the literature regarding the factors affecting the prognosis of COVID-19 in cancer subgroups. Larger, prospective studies are needed to clarify this situation.
In severe COVID-19; infection-induced coagulopathy and secondary hyperfibrinolysis have been demonstrated (17). In our study, while fibrinogen level was significant in univariate analysis, it was statistically insignificant in multivariate analysis. This result may be related to the small sample size.
Also, the other study included non-cancer patients. The results may not have been significant because cancer patients already have hypercoagulopathy. Further studies are needed on this subject.
However, our findings are also based on some study limitations. First, the study was retrospective and based on a small sample size.