The outcome of gynecologic cancer patients with Covid-19 infection: A systematic review and meta-analysis

Abstract

Background:  Cancer is a comorbidity that leads to progressive worsening of coronavirus disease 2019 (Covid-19) with increased mortality. This is a systematic review and meta-analysis to yield evidence of adverse outcomes of Covid-19 in gynecologic cancer. Methods:  Searches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021–19 February 2022). The Newcastle-Ottawa Scale tool was used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI) and random-effects model were presented. Results:  We accepted 51 studies (a total of 1991 gynecologic cancer patients with Covid-19). Covid-19 infection cases were lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56-0.90,  p  0.005). Severe Covid-19 infection and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16-0.80,  p  0.01), (OR 0.52, CI 0.44-0.62,  p  <0.0001), (OR 0.26, CI 0.10-0.67  p  0.005), (OR 0.63, CI 0.47-0.83,  p  0.001) respectively. Increased Covid death was seen in gynecologic cancer vs population with breast cancer, non-Covid cancer, and non-cancer Covid (OR 1.50, CI 1.20-1.88,  p  0.0004), (OR 11.83, CI 8.20-17.07,  p  <0.0001), (OR 2.98, CI 2.23-3.98,  p  <0.0001) respectively.     Conclusion:  Gynecologic cancer has higher Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer has fewer Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. These findings may aid health policies and services during the ongoing global pandemic. PROSPERO Registration: CRD42021256557 (22/05/21)