Association of prior SARS-CoV-2 infection with advanced cancer presentation in newly diagnosed solid tumors: A real-world data analysis.

10586 Background: Emerging evidence suggests that the impact of SARS-CoV-2 infection may extend beyond acute respiratory illness, with potential implications for cancer biology. Recent proteomic analyses and reviews have highlighted several ways in which SARS-CoV-2 might interact with host pathways relevant to oncogenesis, tumor progression, and cellular plasticity. Taken together, these findings support a plausible biological rationale that COVID-19 infection may influence the clinical behavior or progression of solid tumors, potentially leading to diagnosis at later stages or the emergence of more aggressive phenotypes. In this study, we use real-world data from the TriNetX US Collaborative network to test the hypothesis that patients with solid tumors who have had COVID-19 are more likely to present with advanced-stage disease compared to those without a history of SARS-CoV-2 infection. Methods: We conducted a retrospective cohort study of adults (≥18 years) with newly diagnosed solid tumors, including breast, lung, colorectal, and prostate cancers, between January 1, 2021, and December 1, 2025. Patients were categorized based on documented SARS-CoV-2 infection prior to cancer diagnosis (COVID-positive vs COVID-negative), defined using ICD-10 codes and laboratory-confirmed PCR or antigen testing. Patients with any prior cancer diagnosis were excluded. The primary outcome was aggressive presentation, defined as AJCC Stage IV, M1 classification, or ICD-10 codes C77–C79 within 90 days of diagnosis. To reduce confounding, 1:1 propensity score matching was performed based on age, sex, race, ethnicity, cancer type, and comorbidities, including obesity, chronic lung disease, chronic kidney disease, diabetes, and hypertension. Results: After 1:1 propensity score matching, 201,131 patients were included in each cohort. Aggressive cancer presentation occurred in 16.8% of COVID-positive patients compared with 15.1% of COVID-negative patients. COVID-positive patients had a higher risk of aggressive disease presentation, corresponding to an absolute risk increase of 1.73% (95% CI, 1.50–1.96) and a relative risk of 1.11 (95% CI, 1.10–1.13). The odds of aggressive presentation were also higher among COVID-positive patients (OR, 1.14; 95% CI, 1.12–1.16; p < 0.0001). Conclusions: Prior COVID-19 infection was associated with a higher likelihood of advanced and metastatic cancer presentation at diagnosis, even after adjustment for demographic factors and comorbidities. These findings highlight the potential long-term oncologic impact of the COVID-19 pandemic and warrant further investigation.