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Are there differences in seroprevalence and antibody levels for SARS-CoV-2 between patients with cancer and health care workers (HCWs) during the COVID-19 pandemic in Japan?
In this cross-sectional study including 500 patients with cancer and 1190 HCWs, the seroprevalence was 1.0% in patients and 0.67% in HCWs. However, the levels of IgG antibodies against nucleocapsid and spike protein were significantly lower in patients than in HCWs.
These findings indicate that seroprevalence was not different in patients with cancer compared with HCWs, but the immune response to SARS-CoV-2 may differ between patients with cancer and HCWs.
Patients with cancer and health care workers (HCWs) are at high risk of SARS-CoV-2 infection. Assessing the antibody status of patients with cancer and HCWs can help understand the spread of COVID-19 in cancer care.
To evaluate serum SARS-CoV-2 antibody status in patients with cancer and HCWs during the COVID-19 pandemic in Japan.
Design, Setting, and Participants
Participants were enrolled for this prospective cross-sectional study between August 3 and October 30, 2020, from 2 comprehensive cancer centers in the epidemic area around Tokyo, Japan. Patients with cancer aged 16 years or older and employees were enrolled. Participants with suspected COVID-19 infection at the time of enrollment were excluded.
Cancer of any type and cancer treatment, including chemotherapy, surgery, immune checkpoint inhibitors, radiotherapy, and targeted molecular therapy.
Main Outcomes and Measures
Seroprevalence and antibody levels in patients with cancer and HCWs. Seropositivity was defined as positivity to nucleocapsid IgG (N-IgG) and/or spike IgG (S-IgG). Serum levels of SARS-CoV-2 IgM and IgG antibodies against the nucleocapsid and spike proteins were measured by chemiluminescent enzyme immunoassay.
A total of 500 patients with cancer (median age, 62.5 years [range, 21-88 years]; 265 men [55.4%]) and 1190 HCWs (median age, 40 years [range, 20-70 years]; 382 men [25.4%]) were enrolled. In patients with cancer, 489 (97.8%) had solid tumors, and 355 (71.0%) had received anticancer treatment within 1 month. Among HCWs, 385 (32.3%) were nurses or assistant nurses, 266 (22.4%) were administrative officers, 197 (16.6%) were researchers, 179 (15.0%) were physicians, 113 (9.5%) were technicians, and 50 (4.2%) were pharmacists. The seroprevalence was 1.0% (95% CI, 0.33%-2.32%) in patients and 0.67% (95% CI, 0.29%-1.32%) in HCWs (P = .48). However, the N-IgG and S-IgG antibody levels were significantly lower in patients than in HCWs (N-IgG: β, −0.38; 95% CI, −0.55 to −0.21; P < .001; and S-IgG: β, −0.39; 95% CI, −0.54 to −0.23; P < .001). Additionally, among patients, N-IgG levels were significantly lower in those who received chemotherapy than in those who did not (median N-IgG levels, 0.1 [interquartile range (IQR), 0-0.3] vs 0.1 [IQR, 0-0.4], P = .04). In contrast, N-IgG and S-IgG levels were significantly higher in patients who received immune checkpoint inhibitors than in those who did not (median N-IgG levels: 0.2 [IQR, 0.1-0.5] vs 0.1 [IQR, 0-0.3], P = .02; S-IgG levels: 0.15 [IQR, 0-0.3] vs 0.1[IQR, 0-0.2], P = .02).
Conclusions and Relevance
In this cross-sectional study of Japanese patients with cancer and HCWs, the seroprevalence of SARS-CoV-2 antibodies did not differ between the 2 groups; however, findings suggest that comorbid cancer and treatment with systemic therapy, including chemotherapy and immune checkpoint inhibitors, may influence the immune response to SARS-CoV-2.
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Accepted for Publication: April 27, 2021.
Published Online: May 28, 2021. doi:10.1001/jamaoncol.2021.2159
Corresponding Author: Tatsuya Yoshida, MD, PhD, Department of Experimental Therapeutics, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan 104-0045 (firstname.lastname@example.org).
Author Contributions: Drs Yazaki and Tatsuya Yoshida had full access to all of the data and take responsibility for their integrity the accuracy of their analysis.
Concept and design: Yazaki, Tatusya Yoshida, Kojima, Yagishita, Nakahama, Shiotsuka, O. Kobayashi, Iwata, Ohe, Tomokazu Yoshida, Hamada, Doi, Yamamoto.
Acquisition, analysis, or interpretation of data: Yazaki, Tatusya Yoshida, Yagishita, Nakahama, Okinaka, Matsushita, Shiotsuka, Iwata, Narita, Ohba, Takahashi, Iwasa, K. Kobayashi, Ohe, Tomokazu Yoshida, Hamada, Doi, Yamamoto.
Drafting of the manuscript: Yazaki, Tatusya Yoshida, Yagishita, O. Kobayashi, Narita, Ohba, Tomokazu Yoshida, Hamada, Doi, Yamamoto.
Critical revision of the manuscript for important intellectual content: Yazaki, Tatusya Yoshida, Kojima, Yagishita, Nakahama, Okinaka, Matsushita, Shiotsuka, Iwata, Ohba, Takahashi, Iwasa, K. Kobayashi, Ohe, Tomokazu Yoshida, Hamada, Doi, Yamamoto.
Statistical analysis: Yazaki, Tatusya Yoshida, Yagishita.
Obtained funding: Tatusya Yoshida, Hamada.
Administrative, technical, or material support: Tatusya Yoshida, Kojima, Yagishita, Nakahama, Matsushita, Ohba, Tomokazu Yoshida, Hamada, Yamamoto.
Supervision: Tatusya Yoshida, Yagishita, O. Kobayashi, Iwata, Ohe, Hamada, Doi, Yamamoto.
Other–Specimen collection: Okinaka.
Conflict of Interest Disclosures: Dr Tatusya Yoshida reported receiving grants and personal fees from AstraZeneca, grants and personal fees from Bristol-Myers Squibb, AbbVie, Merck Sharpe & Dohme, Ono Pharmaceutical, and Chugai; personal fees from Novartis, Taiho Pharmaceutical, Eli Lilly, Boehringer Ingelheim, Roche Diagnostics, and Archer; and grants from Takeda Pharmaceutical outside the submitted work. Dr Yagishita reported receiving grants from Boehringer Ingelheim outside the submitted work. Dr Matsushita reported receiving a research and development commission fee from Asahi Kasei Medical Co. outside the submitted work. Dr Narita reported receiving grants from Ono Pharmaceutical, Eisai, Dainippon-Sumitomo, Taiho, and Daiichi-Sankyo outside the submitted work. Dr Ohe reported receiving grants and personal fees from AstraZeneca, Bristol-Myers Squibb, Chugai, Eli Lilly, Janssen, Kyorin, Nippon Kayaku, Novartis, ONO Pharmaceutical, Merck Sharpe & Dohme, Pfizer, Taiho, and Takeda Pharmaceutical; grants from Amgen and Kissei; and personal fees from Boehringer Ingelheim and Celtrion outside the submitted work. Dr Hamada reported receiving grants from the Japan Health Research Promotion Bureau Research Fund and Sysmex Corporation during the conduct of the study. Dr Doi reported receiving grants from Lilly, Merck Sharpe & Dohme, Merck Serono, Pfizer, IQVIA, and Eisai; personal fees from Merck Sharpe & Dohme, Amgen, Takeda, Chugai, Bayer, Rakuten Medical, ONO Pharmaceutical, Astellas, Oncolys BioPharma, and Otsuka Pharma; and grants and personal fees from Daiichi Sankyo, Sumitomo Dainippon, Taiho, Novartis, Janssen, Boehringer Ingelheim, Bristol Myers Squibb, and AbbVie outside the submitted work. Dr Yamamoto reported receiving grants from Chugai, Taiho, Eisai, Eli Lilly, Astellas, Bristol Myers Squibb, Novartis, Daiichi-Sankyo, Pfizer, Boehringer Ingelheim, Kyowa-Hakko Kirin, Bayer, ONO Pharmaceutical Co., Takeda, Janssen, Merck Sharpe & Dohme, Merck, GlaxoSmithKline, Sumitomo Dainippon, Chiome Bioscience, Otsuka; personal fees from ONO Pharmaceutical, Chugai, AstraZeneca, Pfizer, Lilly, Bristol Myers Squibb, Daiichi-Sankyo, Eisai, Otsuka, Takeda, Boehringer Ingelheim, and Cimic outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by a research fund from the Japan Health Research Promotion Bureau Research Fund (2020-A-1) and also partly supported by Sysmex Co, Japan.
Role of the Funder/Sponsor: Sysmex Co was involved with the review of the manuscript and its approval but not with the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank all the patients, their physicians, and the HCWs involved in this study. We also thank the members of the clinical laboratory center for their support.
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