Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.
Urol Oncol. 2021 Nov;39(11):785.e11-785.e17. doi: 10.1016/j.urolonc.2021.04.004. Epub 2021 May 13.
Race/ethnicity may predispose to higher active treatment rates in septuagenarian or older low risk prostate cancer (CaP) patients. We tested this hypothesis within a contemporary North American cohort.
We relied on the Surveillance, Epidemiology and End Results (SEER) database 2010-2016. The effect of race/ethnicity was tested in univariable and multivariable logistic regression analyses predicting definitive treatment administration. Treatment rates (no local treatment [NLT], external beam radiotherapy [EBRT], radical prostatectomy [RP] and brachytherapy) were examined without, as well as with adjustment for age, socioeconomic status, marital status, residence type, year of diagnosis, other-cause mortality, prostate-specific antigen (PSA) and clinical T stage across races/ethnicities. Moreover, temporal trend analyses were performed.
Of 15,118 septuagenarian or older low risk CaP patients, 11,509 (76.1%) were Caucasian, 1,613 (10.7%) African-American, 1,293 (8.5%) Hispanic/Latino and 703 (4.7%) Asian. No clinically meaningful differences were recorded between races/ethnicities with respect to age at diagnosis, PSA, clinical T stage and percentage of positive biopsy cores. Conversely, clinically meaningful and statistically significant differences were identified in socioeconomic status and treatment modality. Specifically, treatment rates ranged as follows: NLT 41.8-48.2, EBRT 23.0-29.9, RP 13.8-21.8 and brachytherapy 6.4-9.9% across race/ethnicies. After adjustment for patient and tumor characteristics, NLT, EBRT, RP and brachytherapy rates showed virtually no residual heterogeneity between races/ethnicities. Finally, in temporal trend analyses, EBRT rates decreased in all races/ethnicities. Conversely, RP and brachytherapy rates did not change over time.
The rates of active treatment in septuagenarian or older low risk CaP patients are surprisingly elevated in all races/ethnicities, even though they decreased over time. All differences in active treatment rates according to race/ethnicity depend on baseline patient and tumor characteristics.
种族可能导致 70 岁或以上低危前列腺癌（CaP）患者接受更积极的治疗。我们在当代北美队列中检验了这一假设。
我们依赖于监测、流行病学和最终结果（SEER）数据库 2010-2016。在预测确定性治疗管理的单变量和多变量逻辑回归分析中，检验了种族/民族的影响。在不考虑以及考虑年龄、社会经济地位、婚姻状况、居住类型、诊断年份、其他原因死亡率、前列腺特异性抗原（PSA）和临床 T 分期的情况下，检查了治疗率（无局部治疗[NLT]、外束放射治疗[EBRT]、根治性前列腺切除术[RP]和近距离放射治疗）在不同种族/民族之间。此外，还进行了时间趋势分析。
在 15118 名 70 岁或以上低危 CaP 患者中，11509 名（76.1%）为白种人，1613 名（10.7%）为非裔美国人，1293 名（8.5%）为西班牙裔/拉丁裔，703 名（4.7%）为亚裔。在诊断时的年龄、PSA、临床 T 分期和阳性活检核心百分比方面，不同种族/民族之间没有明显的临床差异。然而，在社会经济地位和治疗方式方面存在明显且具有统计学意义的差异。具体而言，治疗率如下：NLT 为 41.8-48.2%，EBRT 为 23.0-29.9%，RP 为 13.8-21.8%，近距离放射治疗为 6.4-9.9%。在调整患者和肿瘤特征后，NLT、EBRT、RP 和近距离放射治疗率在不同种族/民族之间几乎没有残留的异质性。最后，在时间趋势分析中，所有种族/民族的 EBRT 率都有所下降。相反，RP 和近距离放射治疗率随时间没有变化。
在所有种族/民族中，70 岁或以上低危 CaP 患者的积极治疗率都令人惊讶地升高，尽管随着时间的推移有所下降。根据种族/民族的不同，所有积极治疗率的差异都取决于基线患者和肿瘤特征。
