Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
Infect Agent Cancer. 2011 Sep 23;6 Suppl 2(Suppl 2):S2. doi: 10.1186/1750-9378-6-S2-S2.
Prostate cancer is the sixth leading cause of death from cancer among men worldwide. We have previously reported that prostate cancer survival rates for Caribbean-born males in the US was similar to survival rates of African-Americans and was higher than their counterparts diagnosed in the Caribbean. However, it is not clear whether differences in mortality could be attributed to differences in treatment.
This current analysis seeks to further explore reasons for the geographic variation of prostate cancer survival for Caribbean-born men. This analysis included 2,554 Black newly diagnosed prostate cancer cases (960 cases diagnosed in the US and 1,594 cases diagnosed in the Caribbean). Clinical data were extracted from the cancer registry and clinical charts.
There were noted differences in the pattern of treatment for each place of birth category when stratified according to disease stage at diagnosis. Among the patients diagnosed with early-intermediate disease (stage I-III) the majority of US-born Brooklyn men were treated with surgery only (31%) and a similar pattern was observed for Caribbean-born Brooklyn men (35%). In contrast, the majority of Caribbean-born Trinidad & Tobago men were treated with hormone therapy (31%).Caribbean-born men diagnosed in the Caribbean had a significantly higher risk of death from prostate cancer (Adjusted Hazard [AdjHR]: 3.7, 95% Confidence Interval [CI]: 2.8-5.0) when compared with the risk of death for Caribbean-born males diagnosed in the US. This observation was consistent for each treatment group with the exception of the cases treated with hormone therapy only. For these cases, there was no difference in the risk of death between Caribbean-born males diagnosed in the Caribbean (AdjHR: 1.4, 95% CI: 0.8-2.6) compared to Caribbean-born males diagnosed in the US.
In addition to difference in access and utilization of screening, differences in treatment strategy may also be a strong predictor of outcome for Caribbean-born males diagnosed with prostate cancer. Further studies are needed to confirm these findings. In addition, other environmental factors related to survival that was not considered in this analysis also need to be investigated.
前列腺癌是全球男性癌症死亡的第六大主要原因。我们之前曾报告过，美国出生的加勒比男性的前列腺癌存活率与非裔美国人相似，高于在加勒比地区诊断出的患者。然而，尚不清楚死亡率的差异是否归因于治疗方法的差异。
本分析旨在进一步探讨加勒比出生男性前列腺癌生存的地理差异原因。该分析包括 2554 名新诊断为前列腺癌的黑人病例（960 例在美国诊断，1594 例在加勒比诊断）。临床数据从癌症登记处和临床病历中提取。
按诊断时疾病阶段分层，对每个出生地类别，治疗模式存在差异。在诊断为早期-中期疾病（I-III 期）的患者中，大多数在美国出生的布鲁克林男性仅接受手术治疗（31%），而在出生于加勒比的布鲁克林男性中也观察到类似的模式（35%）。相比之下，大多数出生于特立尼达和多巴哥的加勒比男性接受激素治疗（31%）。与出生于美国的加勒比男性相比，出生于加勒比的男性诊断为前列腺癌的死亡风险显著更高（调整后的风险 [AdjHR]：3.7，95%置信区间 [CI]：2.8-5.0）。这种观察结果在每个治疗组中均一致，除了仅接受激素治疗的病例。对于这些病例，在出生于加勒比的男性中，诊断为前列腺癌的死亡风险没有差异（AdjHR：1.4，95%CI：0.8-2.6）与出生于美国的男性相比。
除了筛查的获得和利用差异外，治疗策略的差异也可能是加勒比出生男性诊断为前列腺癌的重要预后因素。需要进一步的研究来证实这些发现。此外，本分析未考虑的与生存相关的其他环境因素也需要进行调查。
