Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Clin Genitourin Cancer. 2019 Apr;17(2):139-144. doi: 10.1016/j.clgc.2018.12.003. Epub 2018 Dec 13.
In the United States, the prostate cancer (PCa) incidence and death rate has been greater in non-Hispanic black (NHB) men than in non-Hispanic white (NHW) men and slightly lower in Hispanic men than in NHW men. We compared the sociodemographic and baseline prognostic factors at the diagnosis of PCa in different races/ethnicities at a large, academic center serving an ethnically diverse population.
The Montefiore Medical Center Cancer Registry was used to generate a comprehensive list of all patients with PCa diagnosed from 2004 to 2014. The clinical Looking Glass (a proprietary searchable database of patient information) and individual patient medical record review were used to obtain data, including age at diagnosis, socioeconomic status (SES), clinical Gleason score, clinical stage, and prostate-specific antigen level at diagnosis. The patients were classified by self-identified race/ethnicity as Hispanic, NHB, NHW, or other. The χ test was used for categorical variables, and analysis of variance or the Kruskal-Wallis test was used for continuous variables.
We identified 2352 patients with newly diagnosed PCa during the study period, including 778 Hispanic, 1046 NHB, 486 NHW, and 42 other. The NHW men were significantly older at diagnosis (Hispanic, 63.2 years; NHB, 63.4 years; NHW, 67 years; other, 63.0 years; P < .0001). The mean SES for the Hispanic and NHB men was significantly lower (SES below average: Hispanic, 92.8%; NHB, 91.3%; NHW, 56.6%; other, 75%; P < .0001). The Gleason score at diagnosis differed among these race groups (Gleason score ≤6 PCa: Hispanic, 42.8%; NHB, 39.1%; NHW, 52.2%; other, 50%; Gleason score 8-10: Hispanic, 15.8%; NHB, 17.6%; NHW, 14.3%; other, 16.7%; P = .0005). The proportion of men with metastatic disease at diagnosis also differed significantly among the groups (Hispanic, 7.5%; NHB, 9.0%; NHW, 4.3%; other, 9.5%; P = .0139). Using pairwise comparisons, the odds ratio for a higher Gleason score at presentation between NHB and NHW was 1.592 (P < .001) and was 1.378 for Hispanic versus NHW (P = .0200). The pairwise comparison for metastatic disease at diagnosis showed an odds ratio of 2.186 for NHB versus NHW (P = .0087). After adjusting for SES, the odds ratio for a higher Gleason score comparing NHB and NHW was 1.55 (P = .001). Although the odds of metastatic disease were greater in Hispanic men than in NHW men (odds ratio, 1.784), the differences were not statistically significant (P = .1197).
At our center, the clinical features of men from different racial groups differed significantly at the time of newly diagnosed PCa. Differences included age at diagnosis, SES, Gleason score, and proportion with metastatic disease. Our pairwise comparisons between different ethnic groups suggested that PCa in Hispanic men might be more similar to that in NHB than to that in NHW patients and are generally more aggressive at diagnosis.
在美国，非西班牙裔黑人（NHB）男性的前列腺癌（PCa）发病率和死亡率一直高于非西班牙裔白人（NHW）男性，而西班牙裔男性的发病率略低于 NHW 男性。我们比较了在一家服务于多种族人群的大型学术中心，不同种族/族裔的 PCa 患者在诊断时的社会人口统计学和基线预后因素。
Montefiore 医疗中心癌症登记处生成了一份 2004 年至 2014 年间所有 PCa 患者的综合清单。使用专有可搜索的患者信息数据库 Looking Glass 以及个体患者病历审查来获取数据，包括诊断时的年龄、社会经济地位（SES）、临床 Gleason 评分、临床分期和前列腺特异性抗原水平。患者根据自我认定的种族/族裔分为西班牙裔、NHB、NHW 或其他。使用 χ2 检验进行分类变量，使用方差分析或 Kruskal-Wallis 检验进行连续变量。
我们在研究期间确定了 2352 名新诊断为 PCa 的患者，包括 778 名西班牙裔、1046 名 NHB、486 名 NHW 和 42 名其他。NHW 男性的诊断时年龄明显更大（西班牙裔 63.2 岁；NHB 63.4 岁；NHW 67 岁；其他 63.0 岁；P<0.0001）。西班牙裔和 NHB 男性的平均 SES 明显较低（SES 低于平均水平：西班牙裔 92.8%；NHB 91.3%；NHW 56.6%；其他 75%；P<0.0001）。这些种族组的诊断时 Gleason 评分不同（Gleason 评分≤6 PCa：西班牙裔 42.8%；NHB 39.1%；NHW 52.2%；其他 50%；Gleason 评分 8-10：西班牙裔 15.8%；NHB 17.6%；NHW 14.3%；其他 16.7%；P=0.0005）。各组诊断时患有转移性疾病的男性比例也存在显著差异（西班牙裔 7.5%；NHB 9.0%；NHW 4.3%；其他 9.5%；P=0.0139）。使用两两比较，NHB 与 NHW 相比，Gleason 评分较高的优势比为 1.592（P<0.001），西班牙裔与 NHW 相比为 1.378（P=0.0200）。诊断时转移性疾病的两两比较显示 NHB 与 NHW 相比，优势比为 2.186（P=0.0087）。调整 SES 后，NHB 与 NHW 相比，Gleason 评分较高的优势比为 1.55（P=0.001）。尽管西班牙裔男性患有转移性疾病的几率高于 NHW 男性（优势比为 1.784），但差异无统计学意义（P=0.1197）。
在我们中心，不同种族群体的男性在新诊断为 PCa 时的临床特征存在显著差异。差异包括诊断时的年龄、SES、Gleason 评分和患有转移性疾病的比例。我们在不同族裔群体之间的两两比较表明，西班牙裔男性的 PCa 可能与 NHB 男性的 PCa 更为相似，而与 NHW 患者的 PCa 则不太相似，并且在诊断时通常更为侵袭性。
