Department of Urology, University Hospital Frankfurt, Theodor-Stern Kai 7, 60590, Frankfurt am Main, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
World J Urol. 2021 Mar;39(3):787-796. doi: 10.1007/s00345-020-03242-8. Epub 2020 May 26.
The United States Census Bureau recommends distinguishing between "Asians" vs. "Native Hawaiians or Other Pacific Islanders" (NHOPI). We tested for prognostic differences according to this stratification in patients with prostate cancer (PCa) of all stages.
Descriptive statistics, time-trend analyses, Kaplan-Meier plots and multivariate Cox regression models were used to test for differences at diagnosis, as well as for cancer specific mortality (CSM) according to the Census Bureau's definition in either non-metastatic or metastatic patients vs. 1:4 propensity score (PS)-matched Caucasian controls, identified within the Surveillance, Epidemiology and End Results database (2004-2016).
Of all 380,705 PCa patients, NHOPI accounted for 1877 (0.5%) vs. 23,343 (6.1%) remaining Asians vs. 93.4% Caucasians. NHOPI invariably harbored worse PCa characteristics at diagnosis. The rates of PSA ≥ 20 ng/ml, Gleason ≥ 8, T3/T4, N1- and M1 stages were highest for NHOPI, followed by Asians, followed by Caucasians (PSA ≥ 20: 18.4 vs. 14.8 vs. 10.2%, Gleason ≥ 8: 24.9 vs. 22.1, vs. 15.9%, T3/T4: 5.5 vs. 4.2 vs. 3.5%, N1: 4.4 vs. 2.8, vs. 2.7%, M1: 8.3 vs. 4.9 vs. 3.9%). Despite the worst PCa characteristics at diagnosis, NHOPI did not exhibit worse CSM than Caucasians. Moreover, despite worse PCa characteristics, Asians exhibited more favorable CSM than Caucasians in comparisons that focussed on non-metastatic and on metastatic patients.
Our observations corroborate the validity of the distinction between NHOPI and Asian patients according to the Census Bureau's recommendation, since these two groups show differences in PSA, grade and stage characteristics at diagnosis in addition to exhibiting differences in CSM even after PS matching and multivariate adjustment.
美国人口普查局建议区分“亚洲人”与“夏威夷原住民或其他太平洋岛民”（NHOPI）。我们在所有阶段的前列腺癌（PCa）患者中根据这种分层方法检验了预后差异。
使用描述性统计、时间趋势分析、Kaplan-Meier 图和多变量 Cox 回归模型，根据人口普查局的定义，在非转移性或转移性患者中，按比例（1:4）与白人对照组（在 Surveillance, Epidemiology and End Results 数据库中确定，2004-2016 年）比较，检验诊断时以及根据癌症特异性死亡率（CSM）的差异。
在所有 380705 例 PCa 患者中，NHOPI 占 1877 例（0.5%），其余亚洲人占 23343 例（6.1%），而高加索人占 93.4%。NHOPI 患者的 PCa 特征始终较差。PSA≥20ng/ml、Gleason≥8、T3/T4、N1 和 M1 期的比例在 NHOPI 中最高，其次是亚洲人，其次是高加索人（PSA≥20ng/ml：18.4%、14.8%、10.2%；Gleason≥8：24.9%、22.1%、15.9%；T3/T4：5.5%、4.2%、3.5%；N1：4.4%、2.8%、2.7%；M1：8.3%、4.9%、3.9%）。尽管诊断时 PCa 的特征最差，但 NHOPI 并未表现出比高加索人更差的 CSM。此外，尽管 PCa 的特征较差，但在非转移性和转移性患者的比较中，亚洲人表现出比高加索人更有利的 CSM。
我们的观察结果证实了根据人口普查局的建议区分 NHOPI 和亚洲患者的有效性，因为这两组在 PSA、分级和分期特征方面存在差异，此外，即使在 PS 匹配和多变量调整后，它们在 CSM 方面也存在差异。
