Division of Hematology and Oncology, Department of Medicine, University of California at San Francisco, San Francisco, California.
Cancer Prevention Institute of California, Fremont, California.
Cancer. 2019 Feb 1;125(3):453-462. doi: 10.1002/cncr.31826. Epub 2018 Nov 16.
Surgical and medical androgen deprivation therapy (ADT) strategies are comparable in their ability to suppress serum testosterone levels as treatment in patients with metastatic prostate cancer but differ with regard to cost and impact on quality of life. Medical ADT is associated with better long-term quality of life due to the flexibility of possible therapy interruption but comes with a higher cumulative cost. In the current study, the authors examined whether surgical ADT (ie, bilateral orchiectomy) was used differentially by race/ethnicity and other social factors.
The authors identified patients with metastatic disease at the time of diagnosis through the California Cancer Registry. The association between race/ethnicity and receipt of surgical ADT was modeled using multivariable Firth logistic regression adjusting for age, Gleason score, prostate-specific antigen level, clinical tumor and lymph node classification, neighborhood socioeconomic status (SES), insurance, marital status, comorbidities, initial treatment (radiotherapy, chemotherapy), location of care, rural/urban area of residence, and year of diagnosis.
The authors examined a total of 10,675 patients with metastatic prostate cancer, 11.4% of whom were non-Hispanic black, 8.4% of whom were Asian/Pacific Islander, 18.5% of whom were Hispanic/Latino, and 60.5% of whom were non-Hispanic white. In the multivariable model, patients found to be more likely to receive surgical ADT were Hispanic/Latino (odds ratio [OR], 1.32; 95% confidence interval [95% CI], 1.01-1.72), were from a low neighborhood SES (OR, 1.96; 95% CI, 1.34-2.89) or rural area (OR, 1.49; 95% CI, 1.15-1.92), and had Medicaid/public insurance (OR, 2.21; 95% CI, 1.58-3.10). Patients with military/Veterans Affairs insurance were significantly less likely to receive surgical ADT compared with patients with private insurance (OR, 0.34; 95% CI, 0.13-0.88).
Race/ethnicity, neighborhood SES, and insurance status appear to be significantly associated with receipt of surgical ADT. Future research will need to characterize other differences in initial treatments among men with advanced prostate cancer based on race/ethnicity and aim to better understand what factors drive the association between surgical ADT among men of Hispanic origin or those from areas with low neighborhood SES.
手术和医学雄激素剥夺疗法（ADT）策略在抑制转移性前列腺癌患者的血清睾酮水平方面具有相同的能力，但在成本和对生活质量的影响方面有所不同。由于可能中断治疗的灵活性，医学 ADT 与更好的长期生活质量相关，但成本更高。在目前的研究中，作者研究了手术 ADT（即双侧睾丸切除术）是否因种族/民族和其他社会因素而有所不同。
作者通过加利福尼亚癌症登记处确定了在诊断时患有转移性疾病的患者。使用多变量 Firth 逻辑回归模型，根据年龄、Gleason 评分、前列腺特异性抗原水平、临床肿瘤和淋巴结分类、邻里社会经济地位（SES）、保险、婚姻状况、合并症、初始治疗（放疗、化疗）、护理地点、城乡居住地区和诊断年份，对种族/民族与接受手术 ADT 的相关性进行建模。
作者共检查了 10675 名患有转移性前列腺癌的患者，其中 11.4%为非西班牙裔黑人，8.4%为亚裔/太平洋岛民，18.5%为西班牙裔/拉丁裔，60.5%为非西班牙裔白人。在多变量模型中，更有可能接受手术 ADT 的患者是西班牙裔/拉丁裔（比值比[OR]，1.32；95%置信区间[95%CI]，1.01-1.72），来自社会经济地位较低的邻里（OR，1.96；95%CI，1.34-2.89）或农村地区（OR，1.49；95%CI，1.15-1.92），并且拥有医疗补助/公共保险（OR，2.21；95%CI，1.58-3.10）。与拥有私人保险的患者相比，拥有军事/退伍军人事务保险的患者接受手术 ADT 的可能性显著降低（OR，0.34；95%CI，0.13-0.88）。
种族/民族、邻里 SES 和保险状况似乎与接受手术 ADT 显著相关。未来的研究将需要根据种族/民族，描述在接受先进前列腺癌治疗方面的其他差异，并旨在更好地了解是什么因素推动了西班牙裔或社会经济地位较低的邻里地区男性的手术 ADT 之间的关联。
