前列腺癌结局差异：一个种族多元化国家的人群生存分析

Prostate cancer outcomes disparities: Population survival analysis in an ethnically diverse nation.

作者信息

Matti Bashar, Zargar-Shoshtari Kamran

机构信息

Department of Surgery, The University of Auckland, Auckland, New Zealand.

出版信息

Urol Oncol. 2021 Jun;39(6):367.e19-367.e26. doi: 10.1016/j.urolonc.2021.02.023. Epub 2021 Apr 12.

DOI:10.1016/j.urolonc.2021.02.023

PMID:33858746

Abstract

BACKGROUND

Prostate cancer represents a significant health burden on New Zealand men. There are increasing concerns regarding inequities in prostate cancer morbidity and mortality among the different ethnic groups in New Zealand. This study aims to assess ethnic differences in survival outcomes among men newly diagnosed with prostate cancer.

MATERIALS AND METHODS

The analyzed cohort included 42,563 men, 40 years or older, diagnosed with prostate cancer from January 1st, 2000 to January 1st, 2016. Overall and cancer-specific survivals were estimated for the main ethnic groups in New Zealand namely: Māori (indigenous), Pacific, Asian, and European. Hazard ratio (HR) of death from prostate cancer was calculated with Fine-Gray competing risk regression, while adjusting for age, socioeconomic deprivation, year of cancer diagnosis, residential status, presence of urology service, and cancer grade at diagnosis.

RESULTS

Among all ethnic groups, Māori participants consistently had worst survival outcomes. At 15-year follow-up, the overall cumulative survival probabilities were 39.8%, 43.6%, 63.3%, and 46.5%, for Māori, Pacific, Asian and European men, respectively. In the same order, cancer-specific survivals were 62.7%, 64.3%, 79.8% and 72.0%. Māori men had 43% higher risk of dying from prostate cancer when compared to Europeans. This persisted following adjustments in the multivariable model (adjusted HR = 1.44, [95% CI: 1.29-1.61], P< 0.001). Conversely, differences in sociodemographic and cancer characteristics between Pacific and European men could explain the higher mortality risk in the former group (adjusted HR = 1.00, [95% CI: 0.84-1.19], P= 0.990).

CONCLUSIONS

Significant ethnic disparities in prostate cancer survival outcomes are currently present in New Zealand. Several explanations have been proposed to account for this observation including differences in comorbidities, healthcare access and cancer grade at diagnosis.

摘要

背景

前列腺癌给新西兰男性带来了沉重的健康负担。人们越来越关注新西兰不同种族群体在前列腺癌发病率和死亡率方面的不平等现象。本研究旨在评估新诊断为前列腺癌的男性患者生存结果的种族差异。

材料与方法

分析队列包括2000年1月1日至2016年1月1日期间诊断为前列腺癌的42563名40岁及以上男性。对新西兰主要种族群体，即毛利人（原住民）、太平洋岛民、亚洲人和欧洲人的总体生存率和癌症特异性生存率进行了估计。采用Fine-Gray竞争风险回归计算前列腺癌死亡的风险比（HR），同时对年龄、社会经济剥夺程度、癌症诊断年份、居住状况、泌尿外科服务的可及性以及诊断时的癌症分级进行了调整。

结果

在所有种族群体中，毛利参与者的生存结果始终最差。在15年的随访中，毛利、太平洋岛民、亚洲和欧洲男性的总体累积生存概率分别为39.8%、43.6%、63.3%和46.5%。按相同顺序，癌症特异性生存率分别为62.7%、64.3%、79.8%和72.0%。与欧洲男性相比，毛利男性死于前列腺癌的风险高43%。在多变量模型调整后，这种情况仍然存在（调整后的HR = 1.44，[95% CI：1.29 - 1.61]，P < 0.001）。相反，太平洋岛民和欧洲男性在社会人口统计学和癌症特征方面的差异可以解释前一组较高的死亡风险（调整后的HR = 1.00，[95% CI：0.84 - 1.19]，P = 0.990）。