Vigneswaran Hari T, Mittelstaedt Luke, Crippa Alessio, Eklund Martin, Vidal Adriana, Freedland Stephen J, Abern Michael R
Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Prostate Cancer Prostatic Dis. 2022 Feb;25(2):165-173. doi: 10.1038/s41391-021-00425-1. Epub 2021 Jul 8.
Several studies evaluated prostate cancer (PCa) outcomes in Black men on active surveillance (AS); most studies contained few Black men and results were conflicting. We performed a systematic review and meta-analyze of race and outcomes on AS.
A systematic search was performed for articles of men with Grade Group 1 or 2 (GG1 or GG2) PCa on AS. All studies required race-specific comparative progression data. Progression to treatment, PSA, or biopsy progression were considered and relative risk (RR) estimates of Black men progressing were extracted and pooled using random-effects models. Differences by study-level characteristics were evaluated using subgroup and a cumulative meta-analysis by time.
In total, 12 studies were included (3137 Black and 12,206 non-Black men); eight prospective (27%, n = 4210) and four retrospectives (73%, n = 11,133) cohorts. The overall RR of progression for Black men was 1.62 (95%CI, 1.21-2.17), I = 64% (95% CI, 32-80%), (χ = 30.23; P = 0.001; τ = 0.16). Black men with GG1 PCa alone had a higher pooled progression: RR = 1.81 (95% CI, 1.23-2.68). Including only studies with clinical progression (excluding progression to treatment), potentiated results: RR = 1.82 (95%CI, 1.27-2.60). However, a cumulative meta-analysis demonstrated decreasing pooled effect over time, with contemporary studies after 2019 showing a tempered effect (RR: 1.29, 95% CI: 1.20-1.39).
Many studies attribute racial disparity in PCa to delayed presentation of disease, however, AS is unique since all AS eligible men have a low grade and stage PCa. Our findings suggest Black men may have an increased risk of progression during AS, but the association is not so strong that Black men should be discouraged from undergoing AS. Indeed, contemporary evidence suggests stricter inclusion, better confirmatory testing or better access to care may temper these findings. Importantly, these results utilize self-reported race, a social construct that has many limitations.
多项研究评估了接受主动监测（AS）的黑人男性前列腺癌（PCa）的预后情况；大多数研究纳入的黑人男性数量较少，且结果相互矛盾。我们对AS中的种族与预后进行了系统评价和荟萃分析。
对接受AS的1级或2级（GG1或GG2）PCa男性的文章进行系统检索。所有研究都需要种族特异性的比较进展数据。考虑进展至治疗、前列腺特异性抗原（PSA）或活检进展情况，并提取黑人男性进展的相对风险（RR）估计值，使用随机效应模型进行汇总。通过亚组分析和按时间进行的累积荟萃分析来评估研究水平特征的差异。
总共纳入了12项研究（3137名黑人男性和12206名非黑人男性）；8项前瞻性队列研究（27%，n = 4210）和4项回顾性队列研究（73%，n = 11133）。黑人男性进展的总体RR为1.62（95%置信区间，1.21 - 2.17），I² = 64%（95%置信区间，32 - 80%），（χ² = 30.23；P = 0.001；τ² = 0.16）。仅患有GG1 PCa的黑人男性汇总进展率更高：RR = 1.81（95%置信区间，1.23 - 2.68）。仅纳入有临床进展（不包括进展至治疗）的研究，结果增强：RR = 1.82（95%置信区间，1.27 - 2.60）。然而，累积荟萃分析表明，随着时间推移汇总效应逐渐降低，2019年后的当代研究显示效应减弱（RR：1.29，95%置信区间：1.20 - 1.39）。
许多研究将PCa中的种族差异归因于疾病的延迟发现，然而，AS是独特的，因为所有符合AS条件的男性都患有低级别和低分期的PCa。我们的研究结果表明，黑人男性在AS期间进展风险可能增加，但这种关联并不强烈，不应劝阻黑人男性接受AS。事实上，当代证据表明，更严格的纳入标准、更好的确诊检测或更好的医疗服务可缓和这些结果。重要的是，这些结果使用的是自我报告的种族，这是一种有许多局限性的社会结构。
