Wenzel Mike, Würnschimmel Christoph, Nocera Luigi, Colla Ruvolo Claudia, Hoeh Benedikt, Tian Zhe, Shariat Shahrokh F, Saad Fred, Briganti Alberto, Graefen Markus, Preisser Felix, Becker Andreas, Mandel Philipp, Chun Felix K H, Karakiewicz Pierre I
Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Front Oncol. 2022 Aug 19;12:874945. doi: 10.3389/fonc.2022.874945. eCollection 2022.
To test the effect of race/ethnicity on cancer-specific mortality (CSM) after salvage radical prostatectomy (SRP).
We relied on the Surveillance, Epidemiology and End Results database (SEER, 2004-2016) to identify SRP patients of all race/ethnicity background. Univariate and multivariate Cox regression models addressed CSM according to race/ethnicity.
Of 426 assessable SRP patients, Caucasians accounted for 299 (69.9%) vs. 68 (15.9%) African-Americans vs. 39 (9.1%) Hispanics vs. 20 (4.7%) Asians. At diagnosis, African-Americans (64 years) were younger than Caucasians (66 years), but not younger than Hispanics (66 years) and Asians (67 years). PSA at diagnosis was significantly higher in African-Americans (13.2 ng/ml), Hispanics (13.0 ng/ml), and Asians (12.2 ng/ml) than in Caucasians (7.8 ng/ml, p = 0.01). Moreover, the distribution of African-Americans (10.3%-36.6%) and Hispanics (0%-15.8%) varied according to SEER region. The 10-year CSM was 46.5% in African-Americans vs. 22.4% in Caucasians vs. 15.4% in Hispanics vs. 15.0% in Asians. After multivariate adjustment (for age, clinical T stage, lymph node dissection status), African-American race/ethnicity was an independent predictor of higher CSM (HR: 2.2, p < 0.01), but not Hispanic or Asian race/ethnicity. The independent effect of African-American race/ethnicity did not persist after further adjustment for PSA.
African-Americans treated with SRP are at higher risk of CSM than other racial/ethnic groups and also exhibited the highest baseline PSA. The independent effect of African-American race/ethnicity on higher CSM no longer applies after PSA adjustment since higher PSA represents a distinguishing feature in African-American patients.
为了测试种族/族裔对挽救性根治性前列腺切除术后癌症特异性死亡率（CSM）的影响。
我们依据监测、流行病学与最终结果数据库（SEER，2004 - 2016年）来识别所有种族/族裔背景的挽救性根治性前列腺切除术患者。单因素和多因素Cox回归模型根据种族/族裔分析癌症特异性死亡率。
在426例可评估的挽救性根治性前列腺切除术患者中，白人占299例（69.9%），非裔美国人占68例（15.9%），西班牙裔占39例（9.1%），亚裔占20例（4.7%）。在诊断时，非裔美国人（64岁）比白人（66岁）年轻，但不比西班牙裔（66岁）和亚裔（67岁）年轻。诊断时非裔美国人（13.2 ng/ml）、西班牙裔（13.0 ng/ml）和亚裔（12.2 ng/ml）的前列腺特异性抗原（PSA）显著高于白人（7.8 ng/ml，p = 0.01）。此外，非裔美国人（10.3% - 36.6%）和西班牙裔（0% - 15.8%）的分布因SEER地区而异。非裔美国人的10年癌症特异性死亡率为46.5%，白人是22.4%，西班牙裔是15.4%，亚裔是15.0%。多因素调整（针对年龄、临床T分期、淋巴结清扫状态）后，非裔美国人种族/族裔是癌症特异性死亡率较高的独立预测因素（风险比：2.2，p < 0.01），但西班牙裔或亚裔种族/族裔不是。在进一步调整PSA后，非裔美国人种族/族裔的独立影响不再存在。
接受挽救性根治性前列腺切除术治疗的非裔美国人比其他种族/族裔群体有更高的癌症特异性死亡风险，并且其基线PSA也最高。由于较高的PSA是非裔美国患者的一个显著特征，因此在调整PSA后，非裔美国人种族/族裔对较高癌症特异性死亡率的独立影响不再适用。
