Department of Surgery and Population Sciences, University of Utah, Salt Lake City, Utah.
Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
J Urol. 2019 Dec;202(6):1209-1216. doi: 10.1097/JU.0000000000000416. Epub 2019 Jun 27.
There is a differential in prostate cancer mortality between black and white men. Advances in precision medicine have shifted the research focus toward underlying genetic differences. However, nonbiological factors may have a large role in these observed disparities. Therefore, we sought to measure the relative importance of race compared to health care and social factors on prostate cancer specific mortality.
Using the SEER (Surveillance, Epidemiology, and End Results) database we identified 514,878 men diagnosed with prostate cancer at age 40 years or greater between 2004 and 2012. We also selected a subset of black and white men matched by age, stage and birth year. We stratified patients by age 40 to 54, 55 to 69 and 70 years or older and disease stage, resulting in 18 groups. By applying random forest methods with variable importance measures we analyzed 15 variables and interactions across 4 categories of factors (tumor characteristics, race, and health care and social factors) and the relative importance for prostate cancer specific mortality.
Tumor characteristics at diagnosis were the most important factors for prostate cancer mortality. Across all groups race was less than 5% as important as tumor characteristics and only more important than health care and social factors in 2 of the 18 groups. Although race had a significant impact, health care and social factors known to be associated with racial disparities had greater or similarly important effects across all ages and stages.
Eradicating disparities in prostate cancer survival will require a multipronged approach, including advances in precision medicine. Disparities will persist unless health care access and social equality are achieved among all populations.
黑人和白人男性的前列腺癌死亡率存在差异。精准医学的进步将研究重点转移到潜在的遗传差异上。然而，非生物因素在这些观察到的差异中可能起着重要作用。因此，我们试图衡量种族与医疗保健和社会因素相比，对前列腺癌特异性死亡率的相对重要性。
我们使用 SEER（监测、流行病学和最终结果）数据库，确定了 514878 名年龄在 40 岁或以上、2004 年至 2012 年期间诊断为前列腺癌的男性。我们还选择了一组按年龄、分期和出生年份匹配的黑人和白人男性。我们将患者分为 40-54 岁、55-69 岁和 70 岁或以上三个年龄组，并根据疾病分期进行分层，共分为 18 组。我们应用随机森林方法和变量重要性度量标准，分析了 4 类因素（肿瘤特征、种族以及医疗保健和社会因素）中的 15 个变量及其相互作用，以及它们对前列腺癌特异性死亡率的相对重要性。
诊断时的肿瘤特征是前列腺癌死亡的最重要因素。在所有组中，种族的重要性不到肿瘤特征的 5%，并且仅在 18 个组中的 2 个组中比医疗保健和社会因素更重要。尽管种族有显著影响，但与种族差异相关的医疗保健和社会因素在所有年龄和分期中都具有更大或同样重要的影响。
消除前列腺癌生存差距需要采取多管齐下的方法，包括推进精准医学。除非在所有人群中实现医疗保健机会和社会平等，否则差异将持续存在。
