J Natl Compr Canc Netw. 2018 Nov;16(11):1353-1360. doi: 10.6004/jnccn.2018.7060.
The NCCN Clinical Practice Guidelines in Oncology recommend definitive therapy for all men with high-risk localized prostate cancer (PCa) who have a life expectancy >5 years or who are symptomatic. However, the application of these guidelines may vary among ethnic groups. We compared receipt of guideline-concordant treatment between Latino and non-Latino white men in California. California Cancer Registry data were used to identify 2,421 Latino and 8,636 non-Latino white men diagnosed with high-risk localized PCa from 2010 through 2014. The association of clinical and sociodemographic factors with definitive treatment was examined using logistic regression, overall and by ethnicity. Latinos were less likely than non-Latino whites to receive definitive treatment before (odds ratio [OR], 0.79; 95% CI, 0.71-0.88) and after adjusting for age and tumor characteristics (OR, 0.84; 95% CI, 0.75-0.95). Additional adjustment for sociodemographic factors eliminated the disparity. However, the association with treatment differed by ethnicity for several factors. Latino men with no health insurance were considerably less likely to receive definitive treatment relative to insured Latino men (OR, 0.34; 95% CI, 0.23-0.49), an association that was more pronounced than among non-Latino whites (OR, 0.63; 95% CI, 0.47-0.83). Intermediate-versus high-grade disease was associated with lower odds of definitive treatment in Latinos (OR, 0.75; 95% CI, 0.59-0.97) but not non-Latino whites. Younger age and care at NCI-designated Cancer Centers were significantly associated with receipt of definitive treatment in non-Latino whites but not in Latinos. California Latino men diagnosed with localized high-risk PCa are at increased risk for undertreatment. The observed treatment disparity is largely explained by sociodemographic factors, suggesting it may be ameliorated through targeted outreach, such as that aimed at younger and underinsured Latino men.
美国国家综合癌症网络（NCCN）临床实践指南建议，所有预期寿命> 5 年或有症状的高危局限性前列腺癌（PCa）男性均应接受确定性治疗。然而，这些指南的应用可能因种族群体而异。我们比较了加利福尼亚州拉丁裔和非拉丁裔白人男性接受符合指南的治疗的情况。加利福尼亚癌症登记处的数据用于确定 2010 年至 2014 年间被诊断为高危局限性 PCa 的 2421 名拉丁裔和 8636 名非拉丁裔白人男性。使用逻辑回归检查临床和社会人口统计学因素与确定性治疗的相关性，总体上和按种族进行检查。与非拉丁裔白人相比，拉丁裔男性在接受确定性治疗之前（比值比 [OR]，0.79；95%置信区间 [CI]，0.71-0.88）和调整年龄和肿瘤特征后（OR，0.84；95%CI，0.75-0.95）的可能性较低。进一步调整社会人口统计学因素消除了差异。然而，对于几个因素，治疗与种族之间的关联不同。没有健康保险的拉丁裔男性接受确定性治疗的可能性明显低于有保险的拉丁裔男性（OR，0.34；95%CI，0.23-0.49），这种关联比非拉丁裔白人更为明显（OR，0.63；95%CI，0.47-0.83）。中危与高危疾病与拉丁裔患者接受确定性治疗的可能性较低相关（OR，0.75；95%CI，0.59-0.97），而非拉丁裔白人则没有。在非拉丁裔白人中，年龄较小和在 NCI 指定的癌症中心接受治疗与接受确定性治疗显著相关，但在拉丁裔中则不然。被诊断为局限性高危 PCa 的加利福尼亚拉丁裔男性接受治疗的风险增加。观察到的治疗差异在很大程度上可以用社会人口统计学因素来解释，这表明可以通过有针对性的外联来改善这种情况，例如针对年轻和没有保险的拉丁裔男性的外联。
