Since December 2019, the pneumonia cases infected with 2019 novel coronavirus have appeared, posing a critical threat to global health. In this study, we performed a meta-analysis to discover the different clinical characteristics between severe and non-severe patients with COVID-19 to find the potential risk factors and predictors of this disease's severity, as well as to serve as a guidance for subsequent epidemic prevention and control work. PubMed, Cochrane Library, Medline, Embase and other databases were searched to collect studies on the difference of clinical characteristics of severe and non-severe patients.Meta-analysis was performed using RevMan 5.3 software, and the funnel plots could be made to evaluate the publication bias. P>0.05 means no statistical significance. Furthermore, a meta-regression analysis was performed by using Stata 15.0 to find the potential factors of the high degree of heterogeneity (I 2 >50%).Sixteen studies have been included, with 1,172 severe patients and 2,803 non-severe patients. Compared with non-severe patients, severe patients were more likely to have the symptoms of dyspnea, hemoptysis, and the complications of ARDS, shock, secondary infection, acute kidney injury, and acute cardiac injury.Interestingly, the former smokers were more prevalent in severe cases as compared to non-severe cases, but there was no difference between the two groups of 'current smokers'. Except for chronic liver disease and chronic kidney disease, the underlying comorbidities of hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), malignancy, cerebrovascular disease, and HIV can make the disease worse. In terms of laboratory indicators, the decreased lymphocyte and platelet count, and the increased levels of white blood cell (WBC), D-dimer, creatine kinase, lactate dehydrogenase, procalcitonin, alanine aminotransferase, aspartate aminotransferase, and C-reactive protein were more prevalent in severe patients. Meta-regression analysis showed that patient age, gender, and proportion of severe cases did not significantly impact on the outcomes of any clinical indexes that showed high degree of heterogeneity in the meta-analysis. In conclusion, the severity of COVID-19 could be evaluated by, radiologic finding, some symptoms like dyspnea and hemoptysis, some laboratory indicators, and smoking history, especially the exsmokers. Compared with non-severe patients, severe patients were more likely to have complications and Zhang et al. Clinical characteristics of COVID-19 in China

Background: Immunotherapy has provided a novel therapeutic option for lung cancer but studies involving patients with advanced non-small cell lung cancer (NSCLC) coupled with various degrees of comorbid chronic obstructive pulmonary disease (COPD) are limited. Thus, we performed a retrospective cohort study to optimize the use of immunotherapy in this special population. Methods:We enrolled a total of 99 patients with advanced (stage IIIB/C-IV) NSCLC with comorbid COPD who had received immune checkpoint inhibitors (ICIs) according to the inclusion and exclusion criteria. They were divided into four groups according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline criteria as follows: no COPD group (n 1 =19), mild COPD group (n 2 =24), moderate COPD group (n 3 =31), and severe COPD group (n 4 =25). Routine blood, imaging characteristics, related cytokines including interleukin (IL)-6, IL-8, IL-10, etc., Krebs Von den Lungen (KL)-6, and corresponding indicators of immune-related adverse events (irAEs), incidence of irAEs, objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS) were recorded and analyzed. Comparability of baseline factors above and clinical characteristics were evaluated.Results: There were statistically significant differences in the incidence of irAEs among the four groups (P=0.003). The incidence of irAEs in patients with no COPD (n 1 , 21.1%) and mild to moderate COPD (n 2/3 , 8.3%, 32.3%) was lower than that in patients with severe COPD (n 4 , 56.0%) (P=0.003). The median PFS of the mild to moderate COPD group was significantly longer than the severe COPD group (19.0 vs. 8.00 months, log-rank P=0.004). A significant increase of both ORR (P=0.004) and DCR (P=0.037), as well as higher IL-6 (P=0.000), IL-8 (P=0.026), and IL-10 (P=0.010) levels, have been observed in the mild to moderate COPD group compared with severe COPD group. IL-6 level was an independent factor influencing PFS [P=0.007, 95% confidence interval (95% CI): 1.000-1.002] and COPD grading was an independent predictor of irAEs (P=0.037, 95% CI: 1.035-3.039).Conclusions: Immunotherapy should be selected with caution for advanced NSCLC patients with comorbid severe COPD, considering the limited efficacy and the increased risk of immune-related adverse events related to the immune-checkpoint inhibitors administration in this special population.

Background: Patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD) with poor performance status (PS) are common in clinical practice with few related studies. Present studies have found that weekly low-dose docetaxel or gemcitabine combined with platinum is suitable for elderly or poor PS patients with advanced NSCLC.Methods: Untreated advanced driver mutation-negative NSCLC patients with COPD and PS ≥2 were enrolled in this double-blind randomized trial. Both groups controlled their COPD symptoms according to the GOLD guidelines. The anti-tumor regimens included docetaxel (37.5 mg/m 2 , D1, D8)/carboplatin (AUC 5.0) (DC group) and gemcitabine (1,000 mg/m 2 , D1, D8)/carboplatin (AUC 5.0) (GC group) were used every 3 weeks with continuous chemotherapy for 4-6 cycles or until disease progression. The primary endpoints were progression-free survival (PFS), and overall survival (OS).Results: Among the 52 patients (DC, n=25; GC, n=27), the median follow-up time was 12.3 months.There was no significant difference in tumor overall response rate (ORR; DC, 20.0% vs. GC, 22.2%, P=0.845) and disease control rate (DCR; DC, 72.0% vs. GC, 74.1%, P=0.064) between the 2 groups.The median PFS (GC, 6.5 vs. DC, 5.5 months; P=0.296) and the median OS (GC, 14.9 vs. DC, 12.3 months; P=0.548) of the GC group was slightly longer than the DC group. The main adverse reactions were myelosuppression and there were few adverse reactions of grade 3-4. Compared with the anti-tumor therapy only group in previous literature, the median PFS in this study was longer (6.2 months, 95% CI: 3.533-6.733 vs. 3.5 months, 95% CI: 2.432-4.568; P=0.589). There was also no significant difference in median OS and median PFS between the 2 groups (14.0 vs. 15.0 months, P=0.718).Chemotherapy cycle (P<0.001) was an independent prognostic factor for PFS, while chemotherapy cycle (P=0.011) and PS (P=0.041) were independent prognostic factors for OS. Conclusions: Weekly low-dose docetaxel or gemcitabine combined with carboplatin chemotherapy regimens can yield survival benefits and a tolerable safety profile in patients with driver mutation-negative 2574 Gao et al. Chemotherapy regimen in NSCLC patients complicated with COPD

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Background and Objective: Patients with small cell lung cancer (SCLC) comorbid COPD are not rare clinically, but related studies are limited, and there is no consensus on optimal treatment and prognostic factors for these patients. In this study, the clinical characteristics and the efficacy of different treatment regimens of patients with SCLC comorbid COPD were analyzed retrospectively to explore the optimal regimens and prognostic factors. Patients and methods: A retrospective study was conducted on 97 patients with SCLC who received first-line etoposide combined with platinum chemotherapy from January 1, 2013 to September 31, 2020 in the first affiliated hospital of Guangzhou Medical University.patients were divided into COPD and non-COPD group, progression-free survival (PFS) and overall survival (OS) were compared between the two groups and prognostic factors of SCLC were analyzed. Furthermore, the differences of PFS and OS and prognostic factors were analyzed in the sub-group of COPD patients (COPD treated group and COPD untreated group).Results: There were no significant difference in median PFS (7.4 months VS 7.6 months, p = 0.327) and OS (11.2 months VS 14.5 months, p = 0.081) between COPD group (N = 61) and non-COPD group (N = 36). In the COPD group, 21 patients (34.4%) received COPD treatment. And the median OS of COPD treated group was was longer than that of COPD untreated group (13.4 months VS 10.6 months, p = 0.032), but there existed no significant difference in PFS between the two groups (7.4 months VS 7.0 months, p = 0.648). In patients with SCLC comorbid COPD, multivariate regression analysis indicated that COPD was not a risk factor for OS, while extensive stage was independently associated with poorer OS and chest radiotherapy was independently associated with longger OS.Conclusion: For SCLC patients who received first-line cytotoxic chemotherapy, COPD does not impair prognosis, and COPD treatment was benefit for OS of those comorbid COPD, receiving both COPD treatment and chemotherapy was a preferred option as first-line treatment for patients with SCLC comorbid COPD. Extensive stage and thoracic radiotherapy are independent prognostic factors for OS in patients with SCLC comorbid COPD.