Bioinformatics Core of Xavier NIH RCMI Center of Cancer Research; Department of Computer Science, Xavier University of Louisiana, New Orleans, 70125, LA, USA.
Department of Structural and Cellular Biology, Tulane University School of Medicine, Tulane Cancer Center, New Orleans, 70112, LA, USA.
Sci Rep. 2020 Apr 22;10(1):6820. doi: 10.1038/s41598-020-63764-4.
A major racial disparity in prostate cancer (PCa) is that African American (AA) patients have a higher mortality rate than European American (EA) patients. We filtered the SEER 2009-2011 records and divided them into four groups regarding patient races and cancer grades. On such a partition, we performed a series of statistical analyses to further clarify the aforementioned disparity. Molecular evidence for a primary result of the epidemiological analysis was obtained from gene expression data. The results include: (1) Based on the registry-specific measures, a significant linear regression of total mortality rate (as well as PCa specific mortality rate) on the percentage of (Gleason pattern-based) high-grade cancers (PHG) is demonstrated in EAs (p < 0.01) but not in AAs; (2) PHG and its racial disparity are differentiated across ages and the groups defined by patient outcomes; (3) For patients with cancers in the same grade category, i.e. the high or low grade, the survival stratification between races is not significant in most geographical areas; and (4) The genes differentially expressed between AAs' and EAs' tumors of the same grade category are relatively rare. The perception that prostate tumors are more lethal in AAs than in EAs is reasonable regarding AAs' higher PHG, while high grade alone could not imply aggressiveness. However, this perception is questionable when the comparison is focused on cases within the same grade category. Supporting observations for this conclusion hold a remarkable implication for erasing racial disparity in PCa. That is, "Equal grade, equal outcomes" is not only a verifiable hypothesis but also an achievable public health goal.
前列腺癌（PCa）存在一个主要的种族差异，即非裔美国人（AA）患者的死亡率高于欧洲裔美国人（EA）患者。我们筛选了 SEER 2009-2011 记录，并根据患者种族和癌症分级将其分为四组。在此分区上，我们进行了一系列统计分析，以进一步阐明上述差异。通过基因表达数据获得了流行病学分析主要结果的分子证据。结果包括：（1）基于登记处特定的指标，在 EA 中观察到总死亡率（以及 PCa 特异性死亡率）与高分级癌症（PHG）百分比之间存在显著的线性回归（p < 0.01），但在 AA 中则不存在；（2）PHG 及其在不同种族之间的差异在年龄和患者预后定义的组中存在差异；（3）对于处于相同分级类别的癌症患者，即高分级或低分级，在大多数地理区域中，种族之间的生存分层并不显著；（4）同一分级类别的 AA 和 EA 肿瘤之间差异表达的基因相对较少。考虑到 AA 中的 PHG 较高，认为 AA 中的前列腺肿瘤比 EA 中的更具致命性是合理的，但仅高分级并不能暗示侵袭性。然而，当比较集中在同一分级类别的病例时，这种看法就值得质疑。这一结论的支持性观察结果对消除 PCa 中的种族差异具有重要意义。也就是说，“同等分级，同等结果”不仅是一个可验证的假设，也是一个可以实现的公共卫生目标。
