Roach M, Krall J, Keller J W, Perez C A, Sause W T, Doggett R L, Rotman M, Russ H, Pilepich M V, Asbell S O
Department of Radiation Oncology, University of California, San Francisco 94143-0226.
Int J Radiat Oncol Biol Phys. 1992;24(3):441-9. doi: 10.1016/0360-3016(92)91058-u.
A number of studies have identified race as a prognostic factor for survival from prostate cancer. To evaluate the prognostic significance of race in a controlled setting, we evaluated 1294 patients treated on three prospective randomized trials conducted by the Radiation Therapy Oncology Group between 1976 to 1985. One-hundred and twenty (9%) of the patients were coded as black, while 1077 (83%) of the patients were coded as white. Protocol 7506 included 607 patients with clinical Stage T3-T4Nx or T1b-T2N1-2. Protocol 7706 included 484 patients with clinical Stage T1b or T2 who were node negative. Protocol 8307 included 203 Stage T2b-T4 patients with no lymph node involvement beyond the pelvis. Univariate and multivariate analyses were used to assess the possible independent significance of race and other prognostic factors, including Gleason score, serum acid phosphatase, nodal status, and hormonal status. Protocols 7706 and 8307 revealed that race was not of prognostic significance for disease-free or overall survival by either univariate or multivariate analysis. Univariate analysis of Protocol 7506 revealed that the median survival for blacks was somewhat shorter (5.4 years vs. 7.1 years, p = 0.02). This difference persisted after a multivariate analysis. A higher percentage of blacks treated on 7506 had an abnormally elevated serum acid phosphatase compared to whites (p = 0.006), and the time to distant failure tended to be shorter (p = 0.07). These findings suggest that blacks treated on 7506 may have had more extensive disease at presentation. Based on these prospective randomized trials, it is most likely that the lower survival noted for black Americans with prostate cancer reflects the tendency for blacks to present with more advanced disease. Differences in access to care, the quality of care received, and the impact of co-morbid conditions may explain the lower survival reported for black Americans elsewhere in the literature.
多项研究已将种族确定为前列腺癌生存的一个预后因素。为了在可控环境中评估种族的预后意义，我们评估了1294例在1976年至1985年间由放射治疗肿瘤学组进行的三项前瞻性随机试验中接受治疗的患者。其中120例（9%）患者被编码为黑人，而1077例（83%）患者被编码为白人。方案7506纳入了607例临床分期为T3 - T4Nx或T1b - T2N1 - 2的患者。方案7706纳入了484例临床分期为T1b或T2且淋巴结阴性的患者。方案8307纳入了203例T2b - T4期且盆腔以外无淋巴结受累的患者。采用单因素和多因素分析来评估种族及其他预后因素（包括 Gleason 评分、血清酸性磷酸酶、淋巴结状态和激素状态）的可能独立意义。方案7706和8307显示，无论是单因素分析还是多因素分析，种族对无病生存或总生存均无预后意义。方案7506的单因素分析显示，黑人的中位生存期稍短（5.4年对7.1年，p = 0.02）。多因素分析后这种差异依然存在。与白人相比，在方案7506中接受治疗的黑人血清酸性磷酸酶异常升高的比例更高（p = 0.006），远处转移失败时间往往更短（p = 0.07）。这些发现表明，在方案7506中接受治疗的黑人在就诊时疾病可能更为广泛。基于这些前瞻性随机试验，美国黑人前列腺癌患者生存率较低很可能反映了黑人出现更晚期疾病的倾向。就医机会的差异、所接受治疗的质量以及合并症的影响可能解释了文献中其他地方报道的美国黑人较低的生存率。
