Vol 6, No 2 (2021)
Original article
Published online: 2021-04-16

open access

Page views 742
Article views/downloads 619
Get Citation

Connect on Social Media

Connect on Social Media

COVID-19 infection in cancer patients: the effect of Hepatitis B immunization

Zeynep Oruç1, Senar Ebinç1, Ziya Kalkan1, Muhammet Ali Kaplan1, Mehmet Küçüköner1, Zuhat Urakçı1, İdris Oruç2, Abdurrahman Işıkdoğan1
Medical Research Journal 2021;6(2):86-93.


Introduction: To investigate the clinical characteristics and outcomes of cancer patients with COVID-19 infections and evaluate the effect of hepatitis B immunization status on susceptibility to COVID-19 infection and mortality risk. Materials and methods: The records of 1,515 patients who presented to the Medical Oncology clinic between March 2020 and December 2020 were analysed retrospectively. The demographic and clinical characteristics and laboratory findings of cancer patients with (case group) and without (control group) COVID-19 infection were compared. Results: Of the 1,515 patients, 153 (10.1%) had been diagnosed with COVID-19, and the median age of cancer patients with COVID-19 infection was 53.9 (range; 18–82) years. The most common types of cancer were breast cancer (26.2%), gastrointestinal system cancers (22.3%), genitourinary-system cancers (16.5%) and lung cancer (15.5%). The presence of metastatic disease [hazard ratio (HR): 0.09, 95% CI (0.01–0.83), (p = 0.03)] and receipt of palliative chemotherapy in the cancer patients with COVID-19 infections [HR: 0.1, 95% CI (0.01–0.69), (p = 0.02)] were identified as prognostic factors in multivariate analysis as univariate analysis did not indicate palliative treatment as a prognostic factor. When the case group and control groups were compared in terms of hepatitis B immunization status (p = 0.24), no statistically significant difference was identified between the two groups. Furthermore, hepatitis B immunization status (p = 0.37) were not found to be associated with COVID-19-related mortality risk. Conclusion: Hepatitis B immunization status were not associated with the risk of COVID-19 transmission and mortality. The present study identified the presence of metastatic disease and palliative chemotherapy as negative and positive prognostic factors, respectively.

Article available in PDF format

View PDF Download PDF file


  1. Kuderer NM, Choueiri TK, Shah DP, et al. COVID-19 and Cancer Consortium. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020; 395(10241): 1907–1918.
  2. Dai M, Liu D, Liu M, et al. Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak. Cancer Discov. 2020; 10(6): 783–791.
  3. Ofori-Asenso R, Ogundipe O, Agyeman AA, et al. Cancer is associated with severe disease in COVID-19 patients: a systematic review and meta-analysis. Ecancermedicalscience. 2020; 14: 1047.
  4. Lewis MA. Between Scylla and Charybdis - Oncologic Decision Making in the Time of Covid-19. N Engl J Med. 2020; 382(24): 2285–2287.
  5. Liu Y, Mao B, Liang S, et al. Shanghai Clinical Treatment Experts Group for COVID-19. Association between age and clinical characteristics and outcomes of COVID-19. Eur Respir J. 2020; 55(5).
  6. Lyu J, Miao T, Dong J, et al. Reflection on lower rates of COVID-19 in children: Does childhood immunizations offer unexpected protection? Med Hypotheses. 2020; 143: 109842.
  7. Salman S, Salem ML. Routine childhood immunization may protect against COVID-19. Med Hypotheses. 2020 [Epub ahead of print]; 140: 109689.
  8. Klinger D, Blass I, Rappoport N, et al. Significantly Improved COVID-19 Outcomes in Countries with Higher BCG Vaccination Coverage: A Multivariable Analysis. Vaccines (Basel). 2020; 8(3).
  9. Escobar LE, Molina-Cruz A, Barillas-Mury C. BCG vaccine protection from severe coronavirus disease 2019 (COVID-19). Proc Natl Acad Sci U S A. 2020; 117(30): 17720–17726.
  10. Yu J, Ouyang W, Chua MLK, et al. SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China. JAMA Oncol. 2020; 6(7): 1108–1110.
  11. Bertuzzi AF, Marrari A, Gennaro N, et al. Low Incidence of SARS-CoV-2 in Patients with Solid Tumours on Active Treatment: An Observational Study at a Tertiary Cancer Centre in Lombardy, Italy. Cancers (Basel). 2020; 12(9).
  12. Tozun N, Ozdogan O, Cakaloglu Y, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect. 2015; 21(11): 1020–1026.
  13. Bozza C, Cinausero M, Iacono D, et al. Hepatitis B and cancer: A practical guide for the oncologist. Crit Rev Oncol Hematol. 2016; 98: 137–146.
  14. Cheung KS, Seto WK, Lai CL, et al. Prevention and management of hepatitis B virus reactivation in cancer patients. Hepatol Int. 2016; 10(3): 407–414.
  15. European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. 2012; 57(1): 167–185.
  16. Anugwom CM, Aby ES, Debes JD. Inverse Association Between Chronic Hepatitis B Infection and Coronavirus Disease 2019 (COVID-19): Immune Exhaustion or Coincidence? Clin Infect Dis. 2021; 72(1): 180–182.
  17. Kandeil A, Gomaa MR, El Taweel A, et al. Common childhood vaccines do not elicit a cross-reactive antibody response against SARS-CoV-2. PLoS One. 2020; 15(10): e0241471.
  18. Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020; 5(5): 428–430.
  19. Kunutsor SK, Laukkanen JA. Hepatic manifestations and complications of COVID-19: A systematic review and meta-analysis. J Infect. 2020; 81(3): e72–e74.
  20. Chen L, Huang S, Yang J, et al. Clinical characteristics in patients with SARS-CoV-2/HBV co-infection. J Viral Hepat. 2020; 27(12): 1504–1507.
  21. Garassino MC, Whisenant JG, Huang LC, et al. TERAVOLT investigators. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020; 21(7): 914–922.
  22. Goshen-Lago T, Szwarcwort-Cohen M, Benguigui M, et al. The Potential Role of Immune Alteration in the Cancer-COVID19 Equation-A Prospective Longitudinal Study. Cancers (Basel). 2020; 12(9).
  23. European Society of Medical Oncology (ESMO). Cancer Patient Management During The COVID-19 Pandemic. https://www. esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic (April 10,2020).
  24. Bersanelli M. Controversies about COVID-19 and anticancer treatment with immune checkpoint inhibitors. Immunotherapy. 2020; 12(5): 269–273.
  25. Yang K, Sheng Y, Huang C, et al. Clinical characteristics, outcomes, and risk factors for mortality in patients with cancer and COVID-19 in Hubei, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020; 21(7): 904–913.
  26. Lee LYW, Cazier JB, Starkey T, et al. UK Coronavirus Cancer Monitoring Project Team, UK Coronavirus Monitoring Project Team. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet. 2020; 395(10241): 1919–1926.