Penn State Cancer Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
Cancer Epidemiol Biomarkers Prev. 2020 Jul;29(7):1365-1373. doi: 10.1158/1055-9965.EPI-19-1232. Epub 2020 Apr 10.
Few studies have examined prostate cancer incidence and aggressiveness in urban-rural Appalachian populations. We examined these rates in urban-rural Appalachia and non-Appalachia Pennsylvania (PA), and the association between these areas and more aggressive prostate cancer at diagnosis.
Men, ages ≥ 40 years with a primary prostate cancer diagnosis, were identified from the 2004-2014 Pennsylvania Cancer Registry. Age-adjusted incidence rates for prostate cancer and more aggressive prostate cancer at diagnosis were calculated by urban-rural Appalachia status. Multivariable Poisson regressions were conducted. Multiple logistic regressions were used to examine the association between the geographic areas and more aggressive prostate cancer, after adjusting for confounders.
There were 94,274 cases, ages 40-105 years, included. Urban non-Appalachia had the highest 2004-2014 age-adjusted incidence rates of prostate cancer and more aggressive prostate cancer (293.56 and 96.39 per 100,000 men, respectively) and rural Appalachia had the lowest rates (256.48 and 80.18 per 100,000 men, respectively). Among the cases, urban Appalachia were more likely [OR = 1.12; 95% confidence interval (CI) = 1.08-1.17] and rural Appalachia were less likely (OR = 0.92; 95% CI = 0.87-0.97) to have more aggressive prostate cancer at diagnosis compared with urban non-Appalachia.
Lower incidence rates and the proportion of aggressive disease in rural Appalachia may be due to lower prostate cancer screening rates. More aggressive prostate cancer at diagnosis among the cases in urban Appalachia may be due to exposures that are prevalent in the region.
Identifying geographic prostate cancer disparities will provide information to design programs aimed at reducing risk and closing the disparity gap.
鲜有研究调查过城乡阿巴拉契亚地区的前列腺癌发病率和侵袭性。本研究旨在调查城乡阿巴拉契亚地区和宾夕法尼亚州非阿巴拉契亚地区的前列腺癌发病率和侵袭性，并分析这些地区与诊断时更具侵袭性的前列腺癌之间的关联。
本研究从 2004 年至 2014 年宾夕法尼亚州癌症登记处中，筛选出年龄≥40 岁、患有原发性前列腺癌的男性患者。根据城乡阿巴拉契亚地区的分布情况，计算前列腺癌和诊断时侵袭性更强的前列腺癌的年龄调整发病率。采用多变量泊松回归分析。采用多变量逻辑回归分析，在调整混杂因素后，分析地理区域与侵袭性更强的前列腺癌之间的关联。
共纳入 94274 例年龄 40-105 岁的患者。城市非阿巴拉契亚地区的前列腺癌和侵袭性更强的前列腺癌发病率最高（2004-2014 年，年龄调整发病率分别为 293.56 和 96.39/10 万男性），农村阿巴拉契亚地区的发病率最低（分别为 256.48 和 80.18/10 万男性）。在这些患者中，城市阿巴拉契亚地区的患者更有可能（OR=1.12；95%置信区间（CI）=1.08-1.17），而农村阿巴拉契亚地区的患者更不可能（OR=0.92；95%CI=0.87-0.97）患有侵袭性更强的前列腺癌。
农村阿巴拉契亚地区的发病率较低，侵袭性疾病的比例较低，可能是由于前列腺癌筛查率较低所致。城市阿巴拉契亚地区患者诊断时更具侵袭性的前列腺癌可能与该地区普遍存在的暴露因素有关。
确定前列腺癌的地理差异将提供信息，以设计旨在降低风险和缩小差距的计划。
