Lee Cheryl T, Dunn Rodney L, Williams Candice, Underwood Willie
Departments of Urology and Biostatistics, Comprehensive Cancer Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
J Urol. 2006 Sep;176(3):927-33; discussion 933-4. doi: 10.1016/j.juro.2006.04.074.
White Americans have a 2-fold higher incidence of bladder cancer than black Americans but the latter have a higher mortality rate. This survival disparity has been attributable largely to the late stage presentation of black patients but other factors likely exist. We examined trends in bladder cancer presentation and survival in white and black patients in a 27-year period to gain additional insight into these factors.
Using Surveillance, Epidemiology, and End Results Program data trends in tumor presentation, treatment and survival were defined in 93,093 patients, including 89,481 white and 3,612 black patients, with bladder cancer. Parameters were measured during 5 and 7-year intervals from 1973 to 1999. Bivariate relationships between patient/disease characteristics, and the time and survival were explored. Cox proportional hazard models were used to examine the independent effect of parameters on disease specific survival.
Median followup was 10 years. Black patients consistently presented with higher stage and grade tumors (each p <0.001). This was most pronounced in black women. A trend toward earlier stage presentation was observed in black and white patients with time (p = 0.05 and <0.001, respectively). Ten-year survival in black and white patients with similar tumor stage and grade was consistently worse in black patients, except those with metastasis. An adjusted multivariable model demonstrated a persistent survival disadvantage in black patients (HR 1.35, p <0.001).
Racial disparities in bladder cancer stage, grade, treatment and adjusted survival continue to exist between white and black Americans despite improvements in stage presentation and survival of localized and regional disease. These data provide the rationale to study treatment decision making, access, delay and potential bias in the black community.
美国白人患膀胱癌的发病率比美国黑人高两倍，但后者的死亡率更高。这种生存差异在很大程度上归因于黑人患者就诊时疾病处于晚期，但可能还存在其他因素。我们研究了27年间白人和黑人患者膀胱癌就诊和生存的趋势，以进一步了解这些因素。
利用监测、流行病学和最终结果计划的数据，确定了93093例膀胱癌患者（包括89481例白人患者和3612例黑人患者）的肿瘤就诊、治疗和生存趋势。在1973年至1999年期间，每隔5年和7年测量相关参数。探讨了患者/疾病特征、时间与生存之间的双变量关系。使用Cox比例风险模型来检验各参数对疾病特异性生存的独立影响。
中位随访时间为10年。黑人患者就诊时肿瘤分期和分级一直较高（均p<0.001）。这在黑人女性中最为明显。随着时间推移，黑人和白人患者都出现了分期提前的趋势（分别为p = 0.05和<0.001）。除有转移的患者外，肿瘤分期和分级相似的黑人和白人患者中，黑人患者的10年生存率一直较差。一个校正后的多变量模型显示黑人患者存在持续的生存劣势（风险比1.35，p<0.001）。
尽管局限性和区域性疾病的分期和生存情况有所改善，但美国白人和黑人在膀胱癌分期、分级、治疗及校正后的生存方面仍存在种族差异。这些数据为研究黑人社区的治疗决策、可及性、延误及潜在偏倚提供了理论依据。
