Ajayi Ayobami, Hwang Wei-Ting, Vapiwala Neha, Rosen Mark, Chapman Christina H, Both Stefan, Shah Meera, Wang Xingmei, Agawu Atu, Gabriel Peter, Christodouleas John, Tochner Zelig, Deville Curtiland
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
Adv Radiat Oncol. 2016 Jul 25;1(4):325-332. doi: 10.1016/j.adro.2016.07.003. eCollection 2016 Oct-Dec.
There is growing evidence supporting incorporating multiparametric (mp) magnetic resonance imaging (MRI) scans into risk stratification, active surveillance, and treatment paradigms for prostate cancer. The purpose of our study was to determine whether demographic disparities exist in staging MRI utilization for prostate cancer patients.
An institutional database of 705 nonmetastatic prostate cancer patients treated with radiation therapy from 2005 through 2013 was used to identify patients undergoing versus not undergoing pretreatment diagnostic prostate mpMRI. Uni- and multivariable logistic regression evaluated the relationship of clinical and demographic characteristics with MRI utilization.
All demographic variables assessed, except the other race category, were significantly associated with MRI utilization (all < .05), including age (odds ratio [OR], 0.92), black race (OR, 0.51), poverty (OR, 0.53), closer distance to radiation facility (OR, 1.79), and nonprivate primary insurance (OR, 0.57) on univariable analysis, while clinical stage T3 (OR, 3.37) was the only clinical characteristic. On multivariable analysis stratified by D'Amico risk group, age remained significant across all risk groups, whereas the black versus white racial (OR, 0.21; 95% confidence interval, 0.08-0.55) and nonprivate versus private insurance type (OR, 0.37; 95% confidence interval, 0.16-0.86) disparities persisted in the low-risk group. Clinical stage T3 remained associated in the high-risk group. For race specifically, the percentages of whites, blacks, and others undergoing MRI in the overall cohort and by risk group were, respectively: overall, 80% (343/427), 68% (156/231), and 85% (40/47); low risk, 86%, 56%, and 63%; intermediate risk, 79%, 72%, and 95%; and high risk, 72%, 72%, and 100%.
In this urban, academic center cohort, older patients across all risk groups and black or nonprivate insurance patients in the low risk group were less likely to undergo staging prostate MRI scans. Further research should investigate these differences to ensure equitable utilization across all demographic groups considering the burden of prostate cancer disparities.
越来越多的证据支持将多参数（mp）磁共振成像（MRI）扫描纳入前列腺癌的风险分层、主动监测和治疗模式中。我们研究的目的是确定前列腺癌患者在分期MRI使用方面是否存在人口统计学差异。
使用一个机构数据库，该数据库包含2005年至2013年接受放射治疗的705例非转移性前列腺癌患者，以识别接受与未接受治疗前诊断性前列腺mpMRI的患者。单变量和多变量逻辑回归评估了临床和人口统计学特征与MRI使用之间的关系。
除“其他种族”类别外，所有评估的人口统计学变量均与MRI使用显著相关（均P<0.05），单变量分析包括年龄（比值比[OR]，0.92）、黑人种族（OR，0.51）、贫困（OR，0.53）、距离放射治疗机构较近（OR，1.79）和非私人基本保险（OR，0.57），而临床分期T3（OR，3.37）是唯一的临床特征。在按达米科风险组分层的多变量分析中，年龄在所有风险组中均保持显著，而在低风险组中，黑人与白人种族差异（OR，0.21；95%置信区间，0.08 - 0.55）和非私人与私人保险类型差异（OR，0.37；95%置信区间，0.16 - 0.8）仍然存在。临床分期T3在高风险组中仍具有相关性。具体就种族而言，总体队列以及按风险组划分的白人、黑人和其他种族接受MRI的百分比分别为：总体，80%（343/427）、68%（156/231）和85%（40/47）；低风险，86%、56%和63%；中风险，79%、72%和95%；高风险，72%、72%和100%。
在这个城市学术中心队列中，所有风险组的老年患者以及低风险组中的黑人或非私人保险患者接受分期前列腺MRI扫描的可能性较小。考虑到前列腺癌差异的负担，进一步的研究应调查这些差异，以确保所有人口群体都能公平使用。
