Fowler J E, Bigler S A, Bowman G, Kilambi N K
Department of Pathology, University of Mississippi School of Medicine, Jackson, USA.
J Urol. 2000 Jan;163(1):137-42. doi: 10.1016/s0022-5347(05)67989-x.
We assess the influence of race on stage stratified cause specific survival of men with prostate cancer, and Gleason score, age at diagnosis and treatment on potential racial differences in survival.
A total of 524 black and 396 white men were diagnosed with prostate cancer at a Veterans Affairs Medical Center between January 1982 and December 1992. Clinical stage was determined by retrospective review of the medical records and Gleason score of biopsy material as assigned by a single uropathologist. Of 611 patients who died the cause of death was determined by retrospective or prospective review of hospital records in 493 and by review of the death certificates in 102. In 16 cases the cause of death was indeterminate. Median potential followup was 112 months (range 60 to 182) and median period of observation was 61 months (range 1 to 182).
Cause specific survival with stage T1b-2 cancer was lower in 231 black than in 264 white men of all ages (p = 0.02) and lower in 110 black than in 170 white men younger than in 70 years at diagnosis (p = 0.04). Gleason 7 to 10 cancer, which was associated with a less favorable cause specific survival compared to Gleason 2 to 6 cancer (p <0.0001), was more common in black than in white men with stage T1b-2 cancer of all ages (p = 0.01) and younger than 70 years at diagnosis (p = 0.04). No or unknown treatment status, which was associated with a less favorable cause specific survival compared to treatment (p = 0.05), was more common in black than in white men with stage T1b-2 cancer of all ages (p = 0.0005) but not significantly different when stratified by age. In men of all ages racial differences in cause specific survival were not significant when adjusted for age and Gleason score (p = 0.14) or age, Gleason score and treatment status (p = 0.17). In men younger than 70 years racial differences in cause specific survival were not significant when adjusted for age and Gleason score (p = 0.22). There were no significant racial differences in overall or age stratified all cause survival of men with stage T1b-2 cancer. There were no significant differences in overall or age stratified cause specific or all cause survival of 112 black and 58 white men with stage T3-4 cancer, or 181 and 74, respectively, with metastatic cancer.
Our data indicate that local stage prostate cancer is more lethal in black than in white men and the difference is most pronounced in men younger than 70 years. The survival disadvantage of black men with local stage cancer is due in part to a propensity for development of less differentiated and more aggressive malignancies.
我们评估种族对前列腺癌男性患者按分期分层的特定病因生存率的影响，以及 Gleason 评分、诊断年龄和治疗对生存方面潜在种族差异的影响。
1982 年 1 月至 1992 年 12 月期间，共有 524 名黑人男性和 396 名白人男性在一家退伍军人事务医疗中心被诊断为前列腺癌。通过回顾病历确定临床分期，并由一名泌尿病理学家对活检材料进行 Gleason 评分。在 611 名死亡患者中，493 名通过回顾或前瞻性查阅医院记录确定死因，102 名通过查阅死亡证明确定死因。16 例患者死因不明。中位潜在随访时间为 112 个月（范围 60 至 182 个月），中位观察期为 61 个月（范围 1 至 182 个月）。
所有年龄段的 231 名黑人 T1b - 2 期癌症患者的特定病因生存率低于 264 名白人患者（p = 0.02），诊断时年龄小于 70 岁的 110 名黑人患者低于 170 名白人患者（p = 0.04）。与 Gleason 2 至 6 级癌症相比，Gleason 7 至 10 级癌症的特定病因生存率较差（p <0.0001），在所有年龄段的 T1b - 2 期癌症黑人男性中比白人男性更常见（p = 0.01），在诊断时年龄小于 70 岁的患者中也是如此（p = 0.04）。未治疗或治疗状态不明与治疗相比，特定病因生存率较差（p = 0.05），在所有年龄段的 T1b - 2 期癌症黑人男性中比白人男性更常见（p = 0.0005），但按年龄分层时无显著差异。在所有年龄段的男性中，调整年龄和 Gleason 评分后，特定病因生存率的种族差异不显著（p = 0.14），调整年龄、Gleason 评分和治疗状态后也不显著（p = 0.17）。在年龄小于 70 岁的男性中，调整年龄和 Gleason 评分后，特定病因生存率的种族差异不显著（p = 0.22）。T1b - 2 期癌症男性的总体或按年龄分层的全因生存率无显著种族差异。112 名黑人 T3 - 4 期癌症患者和 58 名白人患者，或分别为 181 名和 74 名转移性癌症患者在总体或按年龄分层的特定病因或全因生存率方面无显著差异。
我们的数据表明，局部期前列腺癌在黑人男性中比白人男性更具致死性，且这种差异在年龄小于 70 岁的男性中最为明显。黑人局部期癌症患者的生存劣势部分归因于发展为低分化和更具侵袭性恶性肿瘤的倾向。
