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Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

. 2020 Jun 20;395(10241):1907-1918. doi: 10.1016/S0140-6736(20)31187-9. Epub 2020 May 28. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study Toni K Choueiri², Dimpy P Shah³, Yu Shyr⁴, Samuel M Rubinstein⁴, Donna R Rivera⁵, Sanjay Shete⁶, Chih-Yuan Hsu⁴, Aakash Desai⁷, Gilberto de Lima Lopes Jr⁸, Petros Grivas⁹, Corrie A Painter¹⁰, Solange Peters¹¹, Michael A Thompson¹², Ziad Bakouny², Gerald Batist¹³, Tanios Bekaii-Saab¹⁴, Mehmet A Bilen¹⁵, Nathaniel Bouganim¹⁶, Mateo Bover Larroya¹⁷, Daniel Castellano¹⁷, Salvatore A Del Prete¹⁸, Deborah B Doroshow¹⁹, Pamela C Egan²⁰, Arielle Elkrief¹³, Dimitrios Farmakiotis²⁰, Daniel Flora²¹, Matthew D Galsky¹⁹, Michael J Glover²², Elizabeth A Griffiths²³, Anthony P Gulati¹⁸, Shilpa Gupta²⁴, Navid Hafez²⁵, Thorvardur R Halfdanarson²⁶, Jessica E Hawley²⁷, Emily Hsu²⁸, Anup Kasi²⁹, Ali R Khaki⁹, Christopher A Lemmon²⁴, Colleen Lewis¹⁵, Barbara Logan²¹, Tyler Masters²⁵, Rana R McKay³⁰, Ruben A Mesa³, Alicia K Morgans³¹, Mary F Mulcahy³¹, Orestis A Panagiotou³², Prakash Peddi³³, Nathan A Pennell²⁴, Kerry Reynolds³⁴, Lane R Rosen³³, Rachel Rosovsky³⁴, Mary Salazar³, Andrew Schmidt², Sumit A Shah²², Justin A Shaya³⁰, John Steinharter², Keith E Stockerl-Goldstein³⁵, Suki Subbiah³⁶, Donald C Vinh¹⁶, Firas H Wehbe³¹, Lisa B Weissmann³⁷, Julie Tsu-Yu Wu²², Elizabeth Wulff-Burchfield²⁹, Zhuoer Xie²⁶, Albert Yeh⁹, Peter P Yu³⁸, Alice Y Zhou³⁵, Leyre Zubiri³⁴, Sanjay Mishra⁴, Gary H Lyman⁹, Brian I Rini⁴, Jeremy L Warner³⁹; COVID-19 and Cancer Consortium

Collaborators, Affiliations

Collaborators

COVID-19 and Cancer Consortium: Maheen Abidi, Jared D Acoba, Neeraj Agarwal, Syed Ahmad, Archana Ajmera, Jessica Altman, Anne H Angevine, Nilo Azad, Michael H Bar, Aditya Bardia, Jill Barnholtz-Sloan, Briana Barrow, Babar Bashir, Rimma Belenkaya, Stephanie Berg, Eric H Bernicker, Christine Bestvina, Rohit Bishnoi, Genevieve Boland, Mark Bonnen, Gabrielle Bouchard, Daniel W Bowles, Fiona Busser, Angelo Cabal, Paolo Caimi, Theresa Carducci, Carla Casulo, James L Chen, Jessica M Clement, David Chism, Erin Cook, Catherine Curran, Ahmad Daher, Mark Dailey, Saurabh Dahiya, John Deeken, George D Demetri, Sandy DiLullo, Narjust Duma, Rawad Elias, Bryan Faller, Leslie A Fecher, Lawrence E Feldman, Christopher R Friese, Paul Fu, Julie Fu, Andy Futreal, Justin Gainor, Jorge Garcia, David M Gill, Erin A Gillaspie, Antonio Giordano, Mary Grace Glace, Axel Grothey, Shuchi Gulati, Michael Gurley, Balazs Halmos, Roy Herbst, Dawn Hershman, Kent Hoskins, Rohit K Jain, Salma Jabbour, Alokkumar Jha, Douglas B Johnson, Monika Joshi, Kaitlin Kelleher, Jordan Kharofa, Hina Khan, Jeanna Knoble, Vadim S Koshkin, Amit A Kulkarni, Philip E Lammers, John C Leighton Jr, Mark A Lewis, Xuanyi Li, Ang Li, K M Steve Lo, Arturo Loaiza-Bonilla, Patricia LoRusso, Clarke A Low, Maryam B Lustberg, Daruka Mahadevan, Abdul-Hai Mansoor, Michelle Marcum, Merry Jennifer Markham, Catherine Handy Marshall, Sandeep H Mashru, Sara Matar, Christopher McNair, Shannon McWeeney, Janice M Mehnert, Alvaro Menendez, Harry Menon, Marcus Messmer, Ryan Monahan, Sarah Mushtaq, Gayathri Nagaraj, Sarah Nagle, Jarushka Naidoo, John M Nakayama, Vikram Narayan, Heather H Nelson, Eneida R Nemecek, Ryan Nguyen, Pier Vitale Nuzzo, Paul E Oberstein, Adam J Olszewski, Susie Owenby, Mary M Pasquinelli, John Philip, Sabitha Prabhakaran, Matthew Puc, Amelie Ramirez, Joerg Rathmann, Sanjay G Revankar, Young Soo Rho, Terence D Rhodes, Robert L Rice, Gregory J Riely, Jonathan Riess, Cameron Rink, Elizabeth V Robilotti, Lori Rosenstein, Bertrand Routy, Marc A Rovito, M Wasif Saif, Amit Sanyal, Lidia Schapira, Candice Schwartz, Oscar Serrano, Mansi Shah, Chintan Shah, Grace Shaw, Ardaman Shergill, Geoffrey Shouse, Heloisa P Soares, Carmen C Solorzano, Pramod K Srivastava, Karen Stauffer, Daniel G Stover, Jamie Stratton, Catherine Stratton, Vivek Subbiah, Rulla Tamimi, Nizar M Tannir, Umit Topaloglu, Eli Van Allen, Susan Van Loon, Karen Vega-Luna, Neeta Venepalli, Amit K Verma, Praveen Vikas, Sarah Wall, Paul L Weinstein, Matthias Weiss, Trisha Wise-Draper, William A Wood, Wenxin Vincent Xu, Susan Yackzan, Rosemary Zacks, Tian Zhang, Andrea J Zimmer, Jack West

Affiliations

¹ Advanced Cancer Research Group, Kirkland, WA, USA.
² Dana-Farber Cancer Institute, Boston, MA, USA.
³ Mays Cancer Center, UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA.
⁴ Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
⁶ MD Anderson Cancer Center, Houston, TX, USA.
⁷ University of Connecticut, Farmington, CT, USA.
⁸ Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL, USA.
⁹ Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
¹⁰ Count Me In, Cambridge, MA, USA.
¹¹ Lausanne University, Lausanne, Switzerland.
¹² Advocate Aurora Health, Milwaukee, WI, USA.
¹³ Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada.
¹⁴ Mayo Clinic Cancer Center, Phoenix, AZ, USA.
¹⁵ Winship Cancer Institute of Emory University, Atlanta, GA, USA.
¹⁶ McGill University Health Centre, Montreal, QC, Canada.
¹⁷ Hospital Universitario 12 de Octubre, Madrid, Spain.
¹⁸ Stamford Hospital, Stamford, CT, USA.
¹⁹ Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²⁰ The Warren Alpert Medical School of Brown University, Providence, RI, USA.
²¹ St. Elizabeth Healthcare, Edgewood, KY, USA.
²² Stanford University, Stanford, CA, USA.
²³ Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
²⁴ Cleveland Clinic, Cleveland, OH, USA.
²⁵ Smilow Cancer Hospital at Yale New Haven, New Haven, CT, USA.
²⁶ Mayo Clinic Cancer Center, Rochester, MN, USA.
²⁷ Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, USA.
²⁸ University of Connecticut, Farmington, CT, USA; Hartford Health Care, Hartford, CT, USA.
²⁹ University of Kansas Medical Center, Kansas City, KS, USA.
³⁰ Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
³¹ The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
³² School of Public Health, Brown University, Providence, RI, USA.
³³ Willis-Knighton Cancer Center, Shreveport, LA, USA.
³⁴ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³⁵ Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA.
³⁶ Stanley S Scott Cancer Center, LSU Health, New Orleans, LA, USA.
³⁷ Mount Auburn Hospital, Cambridge, MA, USA.
³⁸ Hartford Health Care, Hartford, CT, USA.
³⁹ Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: jeremy.warner@vumc.org.

PMID: 32473681
PMCID: PMC7255743
DOI: 10.1016/S0140-6736(20)31187-9

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Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

Nicole M Kuderer et al. Lancet. 2020.

. 2020 Jun 20;395(10241):1907-1918. doi: 10.1016/S0140-6736(20)31187-9. Epub 2020 May 28. Authors Nicole M Kuderer¹, Toni K Choueiri², Dimpy P Shah³, Yu Shyr⁴, Samuel M Rubinstein⁴, Donna R Rivera⁵, Sanjay Shete⁶, Chih-Yuan Hsu⁴, Aakash Desai⁷, Gilberto de Lima Lopes Jr⁸, Petros Grivas⁹, Corrie A Painter¹⁰, Solange Peters¹¹, Michael A Thompson¹², Ziad Bakouny², Gerald Batist¹³, Tanios Bekaii-Saab¹⁴, Mehmet A Bilen¹⁵, Nathaniel Bouganim¹⁶, Mateo Bover Larroya¹⁷, Daniel Castellano¹⁷, Salvatore A Del Prete¹⁸, Deborah B Doroshow¹⁹, Pamela C Egan²⁰, Arielle Elkrief¹³, Dimitrios Farmakiotis²⁰, Daniel Flora²¹, Matthew D Galsky¹⁹, Michael J Glover²², Elizabeth A Griffiths²³, Anthony P Gulati¹⁸, Shilpa Gupta²⁴, Navid Hafez²⁵, Thorvardur R Halfdanarson²⁶, Jessica E Hawley²⁷, Emily Hsu²⁸, Anup Kasi²⁹, Ali R Khaki⁹, Christopher A Lemmon²⁴, Colleen Lewis¹⁵, Barbara Logan²¹, Tyler Masters²⁵, Rana R McKay³⁰, Ruben A Mesa³, Alicia K Morgans³¹, Mary F Mulcahy³¹, Orestis A Panagiotou³², Prakash Peddi³³, Nathan A Pennell²⁴, Kerry Reynolds³⁴, Lane R Rosen³³, Rachel Rosovsky³⁴, Mary Salazar³, Andrew Schmidt², Sumit A Shah²², Justin A Shaya³⁰, John Steinharter², Keith E Stockerl-Goldstein³⁵, Suki Subbiah³⁶, Donald C Vinh¹⁶, Firas H Wehbe³¹, Lisa B Weissmann³⁷, Julie Tsu-Yu Wu²², Elizabeth Wulff-Burchfield²⁹, Zhuoer Xie²⁶, Albert Yeh⁹, Peter P Yu³⁸, Alice Y Zhou³⁵, Leyre Zubiri³⁴, Sanjay Mishra⁴, Gary H Lyman⁹, Brian I Rini⁴, Jeremy L Warner³⁹; COVID-19 and Cancer Consortium Collaborators

COVID-19 and Cancer Consortium: Maheen Abidi, Jared D Acoba, Neeraj Agarwal, Syed Ahmad, Archana Ajmera, Jessica Altman, Anne H Angevine, Nilo Azad, Michael H Bar, Aditya Bardia, Jill Barnholtz-Sloan, Briana Barrow, Babar Bashir, Rimma Belenkaya, Stephanie Berg, Eric H Bernicker, Christine Bestvina, Rohit Bishnoi, Genevieve Boland, Mark Bonnen, Gabrielle Bouchard, Daniel W Bowles, Fiona Busser, Angelo Cabal, Paolo Caimi, Theresa Carducci, Carla Casulo, James L Chen, Jessica M Clement, David Chism, Erin Cook, Catherine Curran, Ahmad Daher, Mark Dailey, Saurabh Dahiya, John Deeken, George D Demetri, Sandy DiLullo, Narjust Duma, Rawad Elias, Bryan Faller, Leslie A Fecher, Lawrence E Feldman, Christopher R Friese, Paul Fu, Julie Fu, Andy Futreal, Justin Gainor, Jorge Garcia, David M Gill, Erin A Gillaspie, Antonio Giordano, Mary Grace Glace, Axel Grothey, Shuchi Gulati, Michael Gurley, Balazs Halmos, Roy Herbst, Dawn Hershman, Kent Hoskins, Rohit K Jain, Salma Jabbour, Alokkumar Jha, Douglas B Johnson, Monika Joshi, Kaitlin Kelleher, Jordan Kharofa, Hina Khan, Jeanna Knoble, Vadim S Koshkin, Amit A Kulkarni, Philip E Lammers, John C Leighton Jr, Mark A Lewis, Xuanyi Li, Ang Li, K M Steve Lo, Arturo Loaiza-Bonilla, Patricia LoRusso, Clarke A Low, Maryam B Lustberg, Daruka Mahadevan, Abdul-Hai Mansoor, Michelle Marcum, Merry Jennifer Markham, Catherine Handy Marshall, Sandeep H Mashru, Sara Matar, Christopher McNair, Shannon McWeeney, Janice M Mehnert, Alvaro Menendez, Harry Menon, Marcus Messmer, Ryan Monahan, Sarah Mushtaq, Gayathri Nagaraj, Sarah Nagle, Jarushka Naidoo, John M Nakayama, Vikram Narayan, Heather H Nelson, Eneida R Nemecek, Ryan Nguyen, Pier Vitale Nuzzo, Paul E Oberstein, Adam J Olszewski, Susie Owenby, Mary M Pasquinelli, John Philip, Sabitha Prabhakaran, Matthew Puc, Amelie Ramirez, Joerg Rathmann, Sanjay G Revankar, Young Soo Rho, Terence D Rhodes, Robert L Rice, Gregory J Riely, Jonathan Riess, Cameron Rink, Elizabeth V Robilotti, Lori Rosenstein, Bertrand Routy, Marc A Rovito, M Wasif Saif, Amit Sanyal, Lidia Schapira, Candice Schwartz, Oscar Serrano, Mansi Shah, Chintan Shah, Grace Shaw, Ardaman Shergill, Geoffrey Shouse, Heloisa P Soares, Carmen C Solorzano, Pramod K Srivastava, Karen Stauffer, Daniel G Stover, Jamie Stratton, Catherine Stratton, Vivek Subbiah, Rulla Tamimi, Nizar M Tannir, Umit Topaloglu, Eli Van Allen, Susan Van Loon, Karen Vega-Luna, Neeta Venepalli, Amit K Verma, Praveen Vikas, Sarah Wall, Paul L Weinstein, Matthias Weiss, Trisha Wise-Draper, William A Wood, Wenxin Vincent Xu, Susan Yackzan, Rosemary Zacks, Tian Zhang, Andrea J Zimmer, Jack West

Affiliations

¹ Advanced Cancer Research Group, Kirkland, WA, USA.
² Dana-Farber Cancer Institute, Boston, MA, USA.
³ Mays Cancer Center, UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA.
⁴ Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
⁶ MD Anderson Cancer Center, Houston, TX, USA.
⁷ University of Connecticut, Farmington, CT, USA.
⁸ Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL, USA.
⁹ Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
¹⁰ Count Me In, Cambridge, MA, USA.
¹¹ Lausanne University, Lausanne, Switzerland.
¹² Advocate Aurora Health, Milwaukee, WI, USA.
¹³ Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC, Canada.
¹⁴ Mayo Clinic Cancer Center, Phoenix, AZ, USA.
¹⁵ Winship Cancer Institute of Emory University, Atlanta, GA, USA.
¹⁶ McGill University Health Centre, Montreal, QC, Canada.
¹⁷ Hospital Universitario 12 de Octubre, Madrid, Spain.
¹⁸ Stamford Hospital, Stamford, CT, USA.
¹⁹ Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²⁰ The Warren Alpert Medical School of Brown University, Providence, RI, USA.
²¹ St. Elizabeth Healthcare, Edgewood, KY, USA.
²² Stanford University, Stanford, CA, USA.
²³ Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
²⁴ Cleveland Clinic, Cleveland, OH, USA.
²⁵ Smilow Cancer Hospital at Yale New Haven, New Haven, CT, USA.
²⁶ Mayo Clinic Cancer Center, Rochester, MN, USA.
²⁷ Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, USA.
²⁸ University of Connecticut, Farmington, CT, USA; Hartford Health Care, Hartford, CT, USA.
²⁹ University of Kansas Medical Center, Kansas City, KS, USA.
³⁰ Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.
³¹ The Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.
³² School of Public Health, Brown University, Providence, RI, USA.
³³ Willis-Knighton Cancer Center, Shreveport, LA, USA.
³⁴ Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
³⁵ Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA.
³⁶ Stanley S Scott Cancer Center, LSU Health, New Orleans, LA, USA.
³⁷ Mount Auburn Hospital, Cambridge, MA, USA.
³⁸ Hartford Health Care, Hartford, CT, USA.
³⁹ Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: jeremy.warner@vumc.org.

PMID: 32473681
PMCID: PMC7255743
DOI: 10.1016/S0140-6736(20)31187-9

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Erratum in

Department of Error.
[No authors listed] [No authors listed] Lancet. 2020 Sep 12;396(10253):758. doi: 10.1016/S0140-6736(20)31870-5. Lancet. 2020. PMID: 32919514 Free PMC article. No abstract available.

Abstract

Background: Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.

Methods: In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with ClinicalTrials.gov, NCT04354701, and is ongoing.

Findings: Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57-76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53-2·21), male sex (1·63, 1·07-2·48), smoking status (former smoker vs never smoked: 1·60, 1·03-2·47), number of comorbidities (two vs none: 4·50, 1·33-15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 vs 0 or 1: 3·89, 2·11-7·18), active cancer (progressing vs remission: 5·20, 2·77-9·77), and receipt of azithromycin plus hydroxychloroquine (vs treatment with neither: 2·93, 1·79-4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07-0·84) or the US-Midwest (0·50, 0·28-0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality.

Interpretation: Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.

Funding: American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.

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Figures
Figure 1

Forest plot of factors associated…

Figure 1

Forest plot of factors associated with 30-day all-cause mortality Data are partially adjusted…

Figure 1

Forest plot of factors associated with 30-day all-cause mortality Data are partially adjusted odds ratios, with 95% CIs. ECOG=Eastern Cooperative Oncology Group. *Adjusted for sex, smoking status, and obesity. †Adjusted for age, sex, smoking status, and obesity. ‡Adjusted for age, sex, and obesity. §Adjusted for age, sex, and smoking status.

Figure 2

Primary and composite secondary outcome…

Figure 2

Primary and composite secondary outcome by cancer type, cancer status, and anticancer therapy…

Figure 2

Primary and composite secondary outcome by cancer type, cancer status, and anticancer therapy Mortality as a function of cancer type and status (A) and cancer type and therapy type (B). Composite outcome as a function of cancer type and status (C) and cancer type and therapy type (D). Results are descriptive; no statistical analyses were applied.

Comment in

Cancer and COVID-19: what do we really know?
Poortmans PM, Guarneri V, Cardoso MJ. Poortmans PM, et al. Lancet. 2020 Jun 20;395(10241):1884-1885. doi: 10.1016/S0140-6736(20)31240-X. Epub 2020 May 29. Lancet. 2020. PMID: 32479827 Free PMC article. No abstract available.
Cancer and COVID-19.
Moris D, Tsilimigras DI, Schizas D. Moris D, et al. Lancet. 2020 Oct 10;396(10257):1066. doi: 10.1016/S0140-6736(20)32069-9. Lancet. 2020. PMID: 33038962 Free PMC article. No abstract available.
Cancer and COVID-19.
Malek AE, Raad II, Jabbour E. Malek AE, et al. Lancet. 2020 Oct 10;396(10257):1066-1067. doi: 10.1016/S0140-6736(20)32070-5. Lancet. 2020. PMID: 33038963 Free PMC article. No abstract available.
Cancer and COVID-19 - Authors' reply.
Kuderer NM, Wulff-Burchfield E, Rubinstein SM, Grivas P, Warner JL. Kuderer NM, et al. Lancet. 2020 Oct 10;396(10257):1067-1068. doi: 10.1016/S0140-6736(20)32065-1. Lancet. 2020. PMID: 33038964 Free PMC article. No abstract available.
Urological Oncology: Bladder, Penis and Urethral Cancer, and Basic Principles OF Oncology.
Chang SS. Chang SS. J Urol. 2021 Nov;206(5):1326-1328. doi: 10.1097/JU.0000000000002156. Epub 2021 Aug 16. J Urol. 2021. PMID: 34392695 No abstract available.