Morrison Belinda F, Aiken William D, Reid Gareth, Mayhew Richard, Hanchard Barrie
University of the West Indies, Mona PO, Kingston 7, Jamaica.
Ecancermedicalscience. 2019 Oct 29;13:971. doi: 10.3332/ecancer.2019.971. eCollection 2019.
Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.
多项研究表明，低风险前列腺癌（PCa）男性存在基于种族的健康差异，非裔美国男性的肿瘤学结局较差。我们试图确定在接受根治性前列腺切除术（RP）治疗的牙买加低风险PCa男性中，病理升级和分期上调的患病率及预测因素。回顾了141名符合美国国立综合癌症网络低风险PCa标准并在单一机构接受RP的男性的数据。所有男性均接受经直肠超声引导下活检。获取术前临床和最终病理数据。数据根据情况总结为均值和标准差或百分比。进行了双变量分析，如独立样本t检验和卡方表分析，并估计了逻辑回归模型以预测升级（Gleason评分>6）和分期上调（p≥T3）。平均年龄为59.5±7.8岁，平均前列腺特异性抗原（PSA）为6.6±2 ng/mL。共有48.3%的男性出现升级，11.4%的男性出现分期上调。双变量分析表明，PSA（p = 0.008）和阳性核心百分比（p = 0.002）与升级相关。PSA（p = 0.042）和阳性核心百分比（p = 0.003）与分期上调显著相关。升级的几率随着PSA水平升高（OR 1.40，95%CI 1.05 - 1.87，p = 0.021）或阳性核心百分比增加（OR 8.27，95%CI 2.19 - 31.16，p = 0.002）而增加。分期上调的几率随着PSA水平升高（OR 1.4，95%CI 1.01 - 1.96，p = 0.046）和阳性核心百分比增加（OR 11.4；95%CI 2.06 - 63.09，p = 0.005）而增加。患有低风险PCa的牙买加男性在RP时存在病理升级和分期上调的高风险。在与这些患者讨论治疗方案时应考虑这些发现。
