Department of Urology, Johns Hopkins University, Baltimore, Maryland.
Department of Urology, University of Michigan, Ann Arbor, Michigan.
Cancer. 2021 May 1;127(9):1425-1431. doi: 10.1002/cncr.33419. Epub 2021 Mar 15.
The aim of this study was to describe pathologic and short-term oncologic outcomes among Black and White men with grade group 4 or 5 prostate cancer managed primarily by radical prostatectomy.
This was a multi-institutional, observational study (2005-2015) evaluating radical prostatectomy outcomes by self-identified race. Descriptive analysis was performed via nonparametric statistical testing to compare baseline clinicopathologic data. Univariable and multivariable time-to-event analyses were performed to assess biochemical recurrence (BCR), metastasis, cancer-specific mortality (CSM), and overall survival between Black and White men.
In total, 1662 men were identified with grade group 4 or 5 prostate cancer initially managed by radical prostatectomy. Black men represented 11.3% of the cohort (n = 188). Black men were younger, demonstrated a longer time from diagnosis to surgery, and were at a lower clinical stage (all P < .05). Black men had lower rates of pT3/4 disease (49.5% vs 63.5%; P < .05) but higher rates of positive surgical margins (31.6% vs 26.5%; P = .14) on pathologic evaluation. There was no difference in BCR, CSM, or overall survival over a median follow-up of 40.7 months. Black men had a lower 5-year cumulative incidence of metastasis-free survival (93.6%; 95% confidence interval [CI], 86.5%-97.0%) in comparison with White men (85.8%; 95% CI, 83.1%-88.0%), which did not persist in an age-adjusted analysis.
Black and White men with high-grade prostate cancer at diagnosis demonstrated similar oncologic outcomes when they were managed by primary radical prostatectomy. Our findings suggest that racial disparities in prostate cancer mortality are not related to differences in the efficacy of extirpative therapy.
本研究旨在描述主要通过根治性前列腺切除术治疗的 4 或 5 级前列腺癌的黑人和白人男性的病理和短期肿瘤学结果。
这是一项多机构、观察性研究（2005-2015 年），通过自我认定的种族评估根治性前列腺切除术的结果。通过非参数统计检验进行描述性分析，以比较基线临床病理数据。进行单变量和多变量时间事件分析，以评估生化复发（BCR）、转移、癌症特异性死亡率（CSM）和黑人和白人男性之间的总生存率。
总共确定了 1662 名患有 4 或 5 级前列腺癌的男性，最初通过根治性前列腺切除术进行治疗。黑人男性占队列的 11.3%（n=188）。黑人男性更年轻，从诊断到手术的时间更长，临床分期更低（均 P<0.05）。黑人男性的 pT3/4 疾病发生率较低（49.5%对 63.5%；P<0.05），但阳性手术切缘率较高（31.6%对 26.5%；P=0.14）。在中位随访 40.7 个月后，BCR、CSM 或总生存率无差异。与白人男性（85.8%；95%置信区间，83.1%-88.0%）相比，黑人男性 5 年无转移生存率（93.6%；95%置信区间，86.5%-97.0%）的累积发生率较低，但在年龄调整分析中并不存在差异。
诊断时患有高级别前列腺癌的黑人和白人男性在接受根治性前列腺切除术治疗时，其肿瘤学结果相似。我们的研究结果表明，前列腺癌死亡率的种族差异与根治性切除术疗效的差异无关。
