Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Cancer Med. 2020 Nov;9(22):8530-8539. doi: 10.1002/cam4.3471. Epub 2020 Sep 23.
There is limited research on the racial/ethnic differences in long-term outcomes for men with untreated, localized prostate cancer.
Men diagnosed with localized, Gleason ≤7 prostate cancer who were not treated within 1 year of diagnosis from 1997-2007 were identified. Cumulative incidence rates of the following events were calculated; treatment initiation, metastasis, death due to prostate cancer and all-cause mortality, accounting for competing risks. The Cox model of all-cause mortality and Fine-Gray sub distribution model to account for competing risks were used to test for racial/ethnic differences in outcomes adjusted for clinical factors.
There were 3925 men in the study, 749 Hispanic, 2415 non-Hispanic white, 559 non-Hispanic African American, and 202 non-Hispanic Asian/Pacific Islander (API). Median follow-up was 9.3 years. At 19 years, overall cumulative incidence of treatment, metastasis, death due to prostate cancer, and all-cause mortality was 25.0%, 14.7%, 11.7%, and 67.8%, respectively. In adjusted models compared to non-Hispanic whites, African Americans had higher rates of treatment (HR = 1.39, 95% CI = 1.15-1.68); they had an increased risk of metastasis beyond 10 years after diagnosis (HR = 4.70, 95% CI = 2.30-9.61); API and Hispanic had lower rates of all-cause mortality (HR = 0.66, 95% CI = 0.52-0.84, and HR = 0.72, 95% CI = 0.62-0.85, respectively), and API had lower rates of prostate cancer mortality in the first 10 years after diagnosis (HR = 0.29, 95% CI = 0.09-0.90) and elevated risks beyond 10 years (HR = 5.41, 95% CI = 1.39-21.11).
Significant risks of metastasis and prostate cancer mortality exist in untreated men beyond 10 years after diagnosis, but are not equally distributed among racial/ethnic groups.
针对未经治疗的局限性前列腺癌男性患者，长期结局的种族/民族差异方面的研究有限。
本研究纳入了 1997 年至 2007 年期间诊断为局限性、Gleason 评分≤7 前列腺癌且在确诊后 1 年内未接受治疗的男性患者。计算了以下事件的累积发生率：治疗开始、转移、死于前列腺癌和全因死亡率，并考虑了竞争风险。使用全因死亡率的 Cox 模型和 Fine-Gray 亚分布模型来考虑竞争风险，以调整临床因素后检验结局的种族/民族差异。
本研究共纳入 3925 名男性患者，其中 749 名为西班牙裔，2415 名为非西班牙裔白人，559 名为非西班牙裔非裔美国人，202 名为非西班牙裔亚裔/太平洋岛民（API）。中位随访时间为 9.3 年。19 年后，总体治疗、转移、死于前列腺癌和全因死亡率的累积发生率分别为 25.0%、14.7%、11.7%和 67.8%。在调整后的模型中，与非西班牙裔白人相比，非裔美国人的治疗率更高（HR=1.39，95%CI=1.15-1.68）；他们在诊断后 10 年以上的转移风险更高（HR=4.70，95%CI=2.30-9.61）；API 和西班牙裔的全因死亡率较低（HR=0.66，95%CI=0.52-0.84，和 HR=0.72，95%CI=0.62-0.85），并且 API 在诊断后 10 年内死于前列腺癌的风险较低（HR=0.29，95%CI=0.09-0.90），在 10 年以上的风险较高（HR=5.41，95%CI=1.39-21.11）。
在诊断后 10 年以上，未经治疗的男性存在转移和前列腺癌死亡的显著风险，但在种族/民族群体之间分布不均。
