Swami Nishwant, Baez Yefri A, Franco Idalid, Nguyen Tiffany, Meiyappan Karthik, Ton Minh, Jain Bhav, Seldon Crystal, Ng Kenrick, Duma Narjust, Alshalalfa Mohammed, Yamoah Kosj, Nguyen Paul L, Mahal Brandon A, Dee Edward Christopher
University of Massachusetts Medical School, Worcester, MA, USA.
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Prostate Cancer Prostatic Dis. 2023 Jun;26(2):309-316. doi: 10.1038/s41391-022-00526-5. Epub 2022 Mar 19.
Despite great heterogeneity amongst Hispanic groups, prostate cancer studies often report Hispanic patients in aggregate. We sought to identify differences in prostate cancer risk group at presentation and treatment status among Hispanic subgroup populations.
Patients with localized prostate adenocarcinoma diagnosed from 2004-2017 were identified in the National Cancer Database (NCDB) and disaggregated by racial subgroup and Hispanic country of origin. Ordinal logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment with intermediate-unfavorable or high-risk disease.
In our sample (n = 895,087), Hispanic men had greater odds of presenting with higher-risk localized prostate cancer compared with non-Hispanic White men (AOR = 1.18 95% CI 1.16-1.21, p < 0.001). Additionally, Hispanic Black men were less likely to present with higher-risk disease than non-Hispanic Black men. Disparities also existed when disaggregated by country of origin, particularly for Mexican men. Amongst men with unfavorable-risk disease, Hispanic men were less likely to receive treatment than non-Hispanic White men (95% CI 0.57-0.67, p < 0.001). The odds of Hispanic Black patients receiving treatment was 2.00 times the odds (95% CI 1.17-3.41 p = 0.011) of non-Hispanic Black patients receiving treatment. Upon disaggregation by country of origin, disparities persisted, particularly for Mexican men.
We found marked heterogeneity when risk group at presentation and treatment for higher-risk disease were disaggregated by racial subgroup and country of origin. Our findings support further collection of disaggregated data in Hispanic communities and study of potential mechanisms underlying the observed differences.
尽管西班牙裔群体之间存在很大的异质性，但前列腺癌研究通常将西班牙裔患者作为一个整体进行报告。我们试图确定西班牙裔亚群体人群在前列腺癌发病时的风险组以及治疗状况方面的差异。
在国家癌症数据库（NCDB）中识别出2004年至2017年诊断为局限性前列腺腺癌的患者，并按种族亚组和西班牙裔的原籍国进行分类。有序逻辑回归确定了（1）在风险逐渐增加的组中发病以及（2）接受中度不良或高危疾病治疗的调整优势比（AOR）及95%置信区间。
在我们的样本（n = 895,087）中，与非西班牙裔白人男性相比，西班牙裔男性患高危局限性前列腺癌的几率更高（AOR = 1.18，95%置信区间1.16 - 1.21，p < 0.001）。此外，西班牙裔黑人男性患高危疾病的可能性低于非西班牙裔黑人男性。按原籍国分类时也存在差异，尤其是墨西哥男性。在患有不良风险疾病的男性中，西班牙裔男性接受治疗的可能性低于非西班牙裔白人男性（95%置信区间0.57 - 0.67，p < 0.001）。西班牙裔黑人患者接受治疗的几率是非西班牙裔黑人患者接受治疗几率的2.00倍（95%置信区间1.17 - 3.41，p = 0.011）。按原籍国分类后，差异仍然存在，尤其是墨西哥男性。
当按种族亚组和原籍国对发病时风险组以及高危疾病的治疗情况进行分类时，我们发现了显著的异质性。我们的研究结果支持在西班牙裔社区进一步收集分类数据，并研究观察到的差异背后的潜在机制。
