其他死因死亡率调整对非裔美国局部前列腺癌患者获得替代治疗方式的影响。
The Effect of Other-cause Mortality Adjustment on Access to Alternative Treatment Modalities for Localized Prostate Cancer Among African American Patients.
机构信息
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montreal, Canada; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Institut du Cancer de Montréal, Montreal, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Eur Urol Oncol. 2018 Aug;1(3):215-222. doi: 10.1016/j.euo.2018.03.007. Epub 2018 May 15.
BACKGROUND
African American (AA) men might be less likely to benefit from certain treatment types for localized prostate cancer (PCa).
OBJECTIVE
To test treatment rate differences between AA and Caucasian patients with clinically localized PCa, with and without adjustment for other-cause mortality (OCM).
DESIGN, SETTING, AND PARTICIPANTS: Within the Surveillance Epidemiology and End Results (SEER) database (2004-2014), we identified 260 309 (94.0%) Caucasian and 15 534 (6.0%) AA patients with PCa.
INTERVENTION
Radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), combination of BT and EBRT (BT+EBRT), or nonlocal treatment (NLT).
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
We used multivariable logistic regression to assess treatment rates according to race, with or without adjustment for OCM risk according to D'Amico risk classification. OCM was defined using a multivariable Cox regression model, developed using a 50% random sample and validated using the remaining 50%.
RESULTS AND LIMITATIONS
Before OCM adjustment, AA patients were less likely to receive RP regardless of D'Amico risk (odds ratio [OR] 0.54 for low risk [LR], 0.45 for intermediate risk [IR], and 0.43 for high risk [HR]) and were less likely to receive BT if D'Amico intermediate risk (OR 0.84) or high risk (OR 0.89). After OCM risk adjustment, AA men were still less likely to receive BT (OR 0.53 for LR, 0.32 for IR, 0.22 for HR) and EBRT (OR 0.74 for LR, 0.69 for IR, 0.83 for HR), but were no longer less likely to receive RP (OR 2.58 for LR, 3.07 for IR, 2.67 for HR) regardless of their D'Amico risk classification. The Cox model of OCM risk was 74.9% accurate in the validation cohort.
CONCLUSIONS
For AA men, rates of treatment for localized PCa depend on OCM risk. Lack of OCM risk adjustment may incorrectly suggest that some treatments are delivered at a lower rate than for Caucasians, and vice versa.
PATIENT SUMMARY
Our study critically appraised the validity of reported prostate cancer treatment rates for African American men when adjustment for other-cause mortality was not performed.
背景
非裔美国人（AA）男性可能不太可能从某些局部前列腺癌（PCa）的治疗类型中受益。
目的
测试临床局部 PCa 患者中 AA 和白种人患者之间的治疗率差异，是否对其他原因死亡率（OCM）进行调整。
设计、地点和参与者：在监测流行病学和最终结果（SEER）数据库（2004-2014 年）中，我们确定了 260309 名（94.0%）白种人和 15534 名（6.0%）AA 患者患有 PCa。
干预措施
根治性前列腺切除术（RP）、外束放射治疗（EBRT）、近距离放射治疗（BT）、BT 和 EBRT 的联合治疗（BT+EBRT）或非局部治疗（NLT）。
测量和统计分析
我们使用多变量逻辑回归根据种族评估治疗率，根据 D'Amico 风险分类根据 OCM 风险进行调整或不进行调整。OCM 使用多变量 Cox 回归模型定义，使用 50%的随机样本开发，并使用剩余的 50%进行验证。
结果和局限性
在未调整 OCM 的情况下，无论 D'Amico 风险如何，AA 患者接受 RP 的可能性均较低（低危的 OR 0.54，中危的 OR 0.45，高危的 OR 0.43），如果 D'Amico 中危（OR 0.84）或高危（OR 0.89），接受 BT 的可能性也较低。在调整 OCM 风险后，AA 男性接受 BT（LR 的 OR 0.53、IR 的 OR 0.32、HR 的 OR 0.22）和 EBRT（LR 的 OR 0.74、IR 的 OR 0.69、HR 的 OR 0.83）的可能性仍然较低，但无论其 D'Amico 风险分类如何，接受 RP 的可能性不再较低（LR 的 OR 2.58、IR 的 OR 3.07、HR 的 OR 2.67）。OCM 风险的 Cox 模型在验证队列中的准确率为 74.9%。
结论
对于 AA 男性，局部 PCa 的治疗率取决于 OCM 风险。如果不进行 OCM 风险调整，可能会错误地表明某些治疗的实施率低于白人，反之亦然。
患者总结
我们的研究批判性地评估了在未进行其他原因死亡率调整时报告的非裔美国男性前列腺癌治疗率的有效性。
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