Merrill R M, Lyon J L
Department of Health Science, Brigham Young University College of Health and Human Performance, Provo, Utah 84602, USA.
Urology. 2000 May;55(5):730-5. doi: 10.1016/s0090-4295(99)00564-6.
Black men have a twofold increased risk of dying of prostate cancer compared to white men. We assessed the extent to which differences in stage and grade at diagnosis, age, multiple primary cancers, and the first course of cancer-directed therapy influence the likelihood of prostate cancer death among diagnosed cases.
Incidence-based mortality (IBM) is a method that involves tracking disease cases from diagnosis to death, such that the mortality event is linked to factors identified with the disease at the time of diagnosis (eg, tumor stage and grade). We applied the IBM method to prostate cancer data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.
Of men diagnosed with prostate cancer, blacks have a significantly greater chance of dying from the disease than do whites. However, once adjustment has been made for stage and grade at diagnosis, age, number of primary cancers, and initial treatment, no difference in the likelihood of prostate cancer mortality between the two races was found. Differences in stage and grade at diagnosis, age, number of primary cancers, and initial treatment each contributed significantly to the greater chance of dying of prostate cancer for black men than for white men.
The results of IBM analysis suggest that black men do not have a statistically greater chance of prostate cancer mortality than white men after adjusting for differences in stage and grade, age, number of primary cancers, and treatment. Later stage at diagnosis is the primary reason for the higher likelihood of prostate cancer mortality among black men compared to white men.
与白人男性相比，黑人男性死于前列腺癌的风险增加了两倍。我们评估了诊断时的分期和分级、年龄、多原发性癌症以及首次癌症导向治疗等差异在多大程度上影响已确诊病例中前列腺癌死亡的可能性。
基于发病率的死亡率（IBM）是一种从诊断追踪疾病病例直至死亡的方法，这样死亡事件就与诊断时确定的疾病相关因素（如肿瘤分期和分级）联系起来。我们将IBM方法应用于美国国家癌症研究所监测、流行病学和最终结果计划中的前列腺癌数据。
在被诊断患有前列腺癌的男性中，黑人死于该疾病的可能性明显高于白人。然而，一旦对诊断时的分期和分级、年龄、原发性癌症数量以及初始治疗进行调整后，发现两个种族之间前列腺癌死亡率的可能性没有差异。诊断时的分期和分级、年龄、原发性癌症数量以及初始治疗方面的差异，每一项都显著导致黑人男性比白人男性死于前列腺癌的可能性更大。
IBM分析结果表明，在对分期和分级、年龄、原发性癌症数量以及治疗方面的差异进行调整后，黑人男性前列腺癌死亡率在统计学上并不高于白人男性。与白人男性相比，诊断时处于更晚期是黑人男性前列腺癌死亡率更高的主要原因。
