Veterans Health Administration San Diego Health Care System, La Jolla, California.
Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California.
Cancer. 2021 Dec 1;127(23):4403-4412. doi: 10.1002/cncr.33824. Epub 2021 Aug 4.
The safety of active surveillance (AS) for African American men compared with non-Hispanic White (White) men with intermediate-risk prostate cancer is unclear.
The authors identified patients with modified National Comprehensive Cancer Network favorable ("low-intermediate") and unfavorable ("high-intermediate") intermediate-risk prostate cancer diagnosed between 2001 and 2015 and initially managed with AS in the Veterans Health Administration database. They analyzed definitive treatment, disease progression, metastases, prostate cancer-specific mortality (PCSM), and all-cause mortality by using cumulative incidences and multivariable competing-risks (disease progression, metastasis, and PCSM) or Cox (all-cause mortality) regression.
The cohort included 1007 men (African Americans, 330 [32.8%]; Whites, 677 [67.2%]) followed for a median of 7.7 years; 773 (76.8%) had low-intermediate-risk disease, and 234 (23.2%) had high-intermediate-risk disease. The 10-year cumulative incidences of definitive treatment were not significantly different (African Americans, 83.5%; 95% confidence interval [CI], 78.5%-88.7%; Whites, 80.6%; 95% CI, 76.6%-84.4%; P = .17). Among those with low-intermediate-risk disease, there were no significant differences in the 10-year cumulative incidences of disease progression (African Americans, 46.8%; 95% CI, 40.0%-53.3%; Whites, 46.9%; 95% CI, 42.1%-51.5%; P = .91), metastasis (African Americans, 7.1%; 95% CI, 3.7%-11.8%; Whites, 10.8%; 95% CI, 7.6%-14.6%; P = .17), or PCSM (African Americans, 3.8%; 95% CI, 1.6%-7.5%; Whites, 3.8%; 95% CI, 2.0%-6.3%; P = .69). In a multivariable regression including the entire cohort, African American race was not associated with increased risks of definitive treatment, disease progression, metastasis, PCSM, or all-cause mortality (all P > .30).
Outcomes in the Veterans Affairs Health System were similar for African American and White men treated for low-intermediate-risk prostate cancer with AS.
非裔美国男性接受主动监测（AS）与非西班牙裔白人（白人）接受中危前列腺癌治疗的安全性尚不清楚。
作者从退伍军人健康管理局数据库中确定了 2001 年至 2015 年间诊断为改良国家综合癌症网络有利（“低-中”）和不利（“高-中”）中危前列腺癌并最初接受 AS 治疗的患者。他们通过累积发生率和多变量竞争风险（疾病进展、转移和前列腺癌特异性死亡率（PCSM））或 Cox（全因死亡率）回归分析了明确的治疗、疾病进展、转移、PCSM 和全因死亡率。
该队列包括 1007 名男性（非裔美国人 330 名[32.8%]；白人 677 名[67.2%]），中位随访 7.7 年；773 名（76.8%）患有低危疾病，234 名（23.2%）患有高危疾病。明确治疗的 10 年累积发生率无显著差异（非裔美国人 83.5%；95%置信区间[CI]，78.5%-88.7%；白人 80.6%；95%CI，76.6%-84.4%；P=0.17）。在患有低危疾病的患者中，疾病进展的 10 年累积发生率无显著差异（非裔美国人 46.8%；95%CI，40.0%-53.3%；白人 46.9%；95%CI，42.1%-51.5%；P=0.91），转移（非裔美国人 7.1%；95%CI，3.7%-11.8%；白人 10.8%；95%CI，7.6%-14.6%；P=0.17）或 PCSM（非裔美国人 3.8%；95%CI，1.6%-7.5%；白人 3.8%；95%CI，2.0%-6.3%；P=0.69）。在包括整个队列的多变量回归中，非裔美国人种族与明确治疗、疾病进展、转移、PCSM 或全因死亡率的风险增加无关（所有 P>.30）。
在退伍军人事务部健康系统中，接受 AS 治疗的低危前列腺癌的非裔美国男性和白人男性的结局相似。
