Patients with Advanced Pancreatic & Biliary Cancer Appear More Vulnerable to SARS-CoV-2 Omicron Variant: An Observational Study during the COVID-19 Outbreak in Shanghai

Abstract Background:There is a great controversy about lethal effect of Omicron Variant on vulnerable populations and the measure of full-open or zero community transmission policy. Thus, we designed an observational study to evaluate the outcomes of Omicron-infected patients with pancreatic & biliary cancer (the so-called “King of Cancer”) in order to provide potential evidence for the most appropriate strategy to counter Omicron transmission in Shanghai.Methods: Omicron infected patients with advanced pancreatic & biliary cancer were enrolled from April 15 to May 31, 2022. Four groups were set in this study: Group 1, Omicron-infected cancer patients (N=4); Group 2, non-infected cancer patients (N=4); Group 3, infected non-cancer-afflicted subjects (N=4); Group 4, non-infected non-cancer-afflicted subjects (N=4). On Day 0, 7 and 14 after infection, the blood samples were dynamically collected from all subjects. The primary endpoints were disease severity and survival. Results:By the endpoints in this observational study, Patients No. 2, 3 and 4 died separately at Day 11, 25 and 13 after viral infection, all of whom were patients with advanced cancer, with the death rate up to 75%. Group 1 presented an overall T cell exhaustion status compared with other groups with obviously lower T cell populations and higher B cell% and CD4+T/CD8+T ratio (P<0.05). Time-course cytokine monitoring results showed that IL-1β was significantly decreased in Group 1 (P<0.05) and generally kept at a low level without obvious fluctuation. IL-6 was markedly increased in infected cancer patients (P<0.01), but remained a low level and had no apparent change during the whole infection process in non-cancer-afflicted subjects. Furthermore, several inflammatory parameter indexes indicated a tight association of Omicron infection with disease course and prognosis of Omicron-infected cancer patients.Conclusions:For patients with advanced pancreatic & biliary cancer, the strict & comprehensive control strategy for COVID-19 epidemic in Shanghai provided a guarantee of low infection and death rate. Conclusively, this policy shall be persisted upon the consideration of the welfare of vulnerable populations.