Division of Urology, Department of Surgery and the Duke Prostate Center, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
Prostate Cancer Prostatic Dis. 2013 Mar;16(1):85-90. doi: 10.1038/pcan.2012.38. Epub 2012 Oct 16.
Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear.
A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml(-1), Gleason sum ≤ 6, and ≤ 33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race.
In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P = 0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P = 0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P = 0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P = 0.05).
Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.
主动监测（AS）在低危前列腺癌（PC）患者中越来越多地被应用。尽管黑种人传统上与不良的 PC 特征相关，但对于接受 AS 治疗的患者，其预后价值尚不清楚。
一项回顾性研究在杜克前列腺中心从 2005 年 1 月至 2011 年 9 月期间确定了 145 名接受 AS 治疗的患者。种族由患者报告，并分为黑人、白人或其他种族。纳入标准包括 PSA<10ng/ml，Gleason 总和≤6，和诊断性活检中有<33%的核心有癌症。主要结局是由于 PC 进展而停止 AS 治疗。在接受 AS 治疗后继续治疗的男性中，分析治疗触发因素、随访 PSA 和活检特征。使用单变量和多变量 Cox 比例风险模型以及按种族分层分析治疗时间。
在我们的 AS 队列中，105 名（72%）为白人，32 名（22%）为黑人，8 名（6%）为其他种族。中位随访时间为 23.0 个月，在此期间，23%的男性继续治疗。种族之间的人口统计学、临床和随访特征没有差异。黑人男性中未投保的比例较高（黑人 15.6%，白人 3.8%，其他种族 0%，P=0.06）。与白人相比，黑人种族与治疗相关（风险比（HR）2.93，P=0.01）。当调整 PC 诊断时的社会经济和临床参数时，黑人种族仍然是治疗的唯一预测因素（HR 3.08，P=0.01）。在接受治疗的男性中，触发因素在黑人男性中不那么常见是由患者驱动的（黑人 8 例，白人 33 例，其他种族 67%，P=0.05）。
黑人种族与因治疗而停止 AS 相关。当调整社会经济和临床参数时，这种关系仍然存在。
