Preisser Felix, Nazzani Sebastiano, Bandini Marco, Marchioni Michele, Tian Zhe, Saad Fred, Chun Felix Kh, Shariat Shahrokh F, Montorsi Francesco, Huland Hartwig, Graefen Markus, Tilki Derya, Karakiewicz Pierre I
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
Int J Urol. 2018 Nov;25(11):929-936. doi: 10.1111/iju.13780. Epub 2018 Aug 26.
To test for racial disparities in lymph node dissection rates, lymph node dissection extent, lymph node invasion rates and cancer-specific mortality in North American African Americans versus non-Hispanic whites, at radical prostatectomy for clinically localized prostate cancer.
Within the Surveillance, Epidemiology and End Results database (2010-2014), we identified 58 974 African Americans or non-Hispanic whites with prostate cancer, who underwent radical prostatectomy with available clinical stage, prostate-specific antigen and biopsy Gleason score. Annual trends were examined. Logistic regression models focused on lymph node dissection rates, lymph node dissection extent (number of removed lymph nodes) and lymph node invasion. Cox regression models tested for differences in cancer-specific mortality. Multivariable models were adjusted for D'Amico risk groups, age and year. Models predicting lymph node invasion and cancer-specific mortality were additionally adjusted for lymph node dissection extent.
Among all patients, 14.5% were African Americans. Lymph node dissection was carried out in 60.0% of African Americans versus 59.5% of non-Hispanic whites (P = 0.4). The median number of removed lymph nodes was five in African Americans versus six in non-Hispanic whites (P < 0.001). Furthermore, 3.1% versus 3.3% of African Americans and non-Hispanic whites, respectively, harbored lymph node invasion (P = 0.3). In multivariable logistic regression models African American race did not affect lymph node dissection or lymph node invasion rates, but lymph node dissection extent was lower in African Americans (hazard ratio 0.9; P < 0.001). No statistical differences in cancer-specific mortality were identified according to race.
Contemporary North American African American patients treated with radical prostatectomy have equal access to lymph node dissection, the same lymph node invasion rates and the same cancer-specific mortality rates as non-Hispanic whites. However, the extent of lymph node dissection is lower in African Americans. The results regarding lymph node dissection rates are encouraging. However, improvements are required regarding lymph node dissection extent in African Americans.
在对临床局限性前列腺癌进行根治性前列腺切除术时，比较北美非裔美国人和非西班牙裔白人在淋巴结清扫率、淋巴结清扫范围、淋巴结侵犯率及癌症特异性死亡率方面的种族差异。
在监测、流行病学与最终结果数据库（2010 - 2014年）中，我们确定了58974例患有前列腺癌的非裔美国人或非西班牙裔白人，他们接受了根治性前列腺切除术，且有可用的临床分期、前列腺特异性抗原和活检Gleason评分。研究了年度趋势。逻辑回归模型聚焦于淋巴结清扫率、淋巴结清扫范围（切除淋巴结数量）和淋巴结侵犯情况。Cox回归模型检验癌症特异性死亡率的差异。多变量模型针对达米科风险组、年龄和年份进行了调整。预测淋巴结侵犯和癌症特异性死亡率的模型还针对淋巴结清扫范围进行了调整。
在所有患者中，14.5%为非裔美国人。60.0%的非裔美国人进行了淋巴结清扫，而非西班牙裔白人为59.5%（P = 0.4）。非裔美国人切除淋巴结数的中位数为5个，非西班牙裔白人为6个（P < 0.001）。此外，分别有3.1% 的非裔美国人和3. 3%的非西班牙裔白人存在淋巴结侵犯（P = 0.3）。在多变量逻辑回归模型中，非裔美国人的种族并未影响淋巴结清扫或淋巴结侵犯率，但非裔美国人的淋巴结清扫范围较小（风险比0.9；P < 0.001）。未发现根据种族在癌症特异性死亡率方面存在统计学差异。
接受根治性前列腺切除术的当代北美非裔美国患者在淋巴结清扫、淋巴结侵犯率和癌症特异性死亡率方面与非西班牙裔白人相同。然而，非裔美国人的淋巴结清扫范围较小。关于淋巴结清扫率的结果令人鼓舞。然而，非裔美国人在淋巴结清扫范围方面仍需改进。
