Underwood Willie, Dunn Rodney L, Williams Candice, Lee Cheryl T
Department of Urology, University of Michigan, Ann Arbor, MI 48105, USA.
J Am Coll Surg. 2006 Feb;202(2):284-90. doi: 10.1016/j.jamcollsurg.2005.09.009. Epub 2005 Dec 19.
In 2005, there were an estimated 63,210 new cases of bladder cancer and 13,180 related deaths in the US. African Americans reportedly have a lower incidence of bladder cancer, but a higher mortality. The objective of this study was to evaluate the gender and geographic differences in bladder cancer survival between Caucasians and African Americans to better understand the racial disparity in bladder cancer survival.
Surveillance Epidemiology and End Results Program (SEER) data were used to evaluate racial differences in bladder cancer survival from 1973 to 1999. Bivariate and multivariate Cox proportional hazard models were performed to determine the relationship between race and survival, adjusting for cancer stage and grade, marital status, region of country, treatment received, and the interaction between race and region.
African Americans were diagnosed with higher grade (p < 0.001) and higher stage (p < 0.001) tumors, compared with Caucasians. In the multivariable model, African-American race was an independent predictor of poor survival, adjusting for age, marital status, region of the country, stage, grade, treatment received, and interaction between race and region. Surprisingly, African Americans diagnosed in the Atlanta metropolitan area had a substantially worse survival.
African Americans were diagnosed with more aggressive and more advanced tumors. Adjusted multivariable models demonstrated a survival advantage for Caucasians, with African-American race being an independent predictor of poor survival, especially when diagnosed in the Atlanta metropolitan area. Racial disparity continues to exist in bladder cancer presentation and survival in the US.
2005年，美国估计有63210例新发膀胱癌病例和13180例相关死亡病例。据报道，非裔美国人膀胱癌发病率较低，但死亡率较高。本研究的目的是评估白种人和非裔美国人在膀胱癌生存方面的性别和地理差异，以更好地了解膀胱癌生存方面的种族差异。
利用监测、流行病学和最终结果计划（SEER）的数据评估1973年至1999年膀胱癌生存方面的种族差异。采用双变量和多变量Cox比例风险模型来确定种族与生存之间的关系，并对癌症分期和分级、婚姻状况、国家地区、接受的治疗以及种族与地区之间的相互作用进行调整。
与白种人相比，非裔美国人被诊断出的肿瘤分级更高（p<0.001）、分期更高（p<0.001）。在多变量模型中，非裔美国人种族是生存不良的独立预测因素，对年龄、婚姻状况、国家地区、分期、分级、接受的治疗以及种族与地区之间的相互作用进行了调整。令人惊讶的是，在亚特兰大大都市区被诊断出的非裔美国人生存情况要差得多。
非裔美国人被诊断出患有更具侵袭性和更晚期的肿瘤。调整后的多变量模型显示白种人具有生存优势，非裔美国人种族是生存不良的独立预测因素，尤其是在亚特兰大大都市区被诊断出时。在美国，膀胱癌的表现和生存方面种族差异仍然存在。
