Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Endocr Relat Cancer. 2023 Jun 2;30(7). doi: 10.1530/ERC-22-0249. Print 2023 Jul 1.
In some primaries, African American race/ethnicity predisposes to higher stage and worse survival. We tested for differences in cancer-specific mortality (CSM) and other-cause mortality (OCM) in patients with adrenocortical carcinoma (ACC) according to African American vs Caucasian race/ethnicity. We hypothesized that African Americans present with higher tumor stage and grade, do not receive the same treatment, and experience worse oncological outcomes than Caucasians. Within Surveillance, Epidemiology, and End Results database, we identified 1016 ACC patients: 123 (12.1%) African Americans vs 893 (87.9%) Caucasians. Propensity score matching (PSM) (age, sex, marital status, grade, T, N, and M stages, and treatment type), Poisson-smoothed cumulative incidence plots, and competing risk regression (CRR) were used. Compared to Caucasians, African Americans were more frequently unmarried (56.9% vs 35.5%, P < 0.001). No clinically meaningful or statistically significant differences were observed for age, grade, T, N, and M stages, as well as treatment type (all P > 0.05). After PSM (1:4), 123 African Americans and 492 Caucasians remained and were included in CRR analysis. In multivariable CRR models, CSM and OCM rates were not different between the two race/ethnicities (hazard ratio: 0.84, P = 0.3). In African Americans, 5-year CSM rates were 31.2% and 75.3% in European Network for the Study of Adrenal Tumors (ENSAT) stages I-II and III-IV, respectively vs 32.9% and 75.4% in Caucasians. Overall 5-year OCM rates were 11.0% vs 10.1% in respectively African Americans and Caucasians. Unlike other primaries, in ACC, African American race/ethnicity is not associated with higher disease stage at initial diagnosis or worse survival.
在一些原发性疾病中，非裔美国人的种族/民族倾向于更高的疾病分期和更差的生存。我们根据非裔美国人和白种人种族/民族，测试了患有肾上腺皮质癌（ACC）的患者的癌症特异性死亡率（CSM）和其他原因死亡率（OCM）的差异。我们假设非裔美国人表现出更高的肿瘤分期和分级，没有接受相同的治疗，并且与白种人相比，他们的肿瘤学结果更差。在监测、流行病学和结果数据库中，我们确定了 1016 名 ACC 患者：123 名（12.1%）非裔美国人与 893 名（87.9%）白种人。采用倾向评分匹配（PSM）（年龄、性别、婚姻状况、分级、T、N 和 M 分期以及治疗类型）、泊松平滑累积发生率图和竞争风险回归（CRR）进行分析。与白种人相比，非裔美国人未婚的比例更高（56.9% vs 35.5%，P < 0.001）。在年龄、分级、T、N 和 M 分期以及治疗类型方面，观察到的差异没有临床意义或统计学意义（均 P > 0.05）。PSM（1:4）后，123 名非裔美国人和 492 名白种人仍然存在，并纳入 CRR 分析。在多变量 CRR 模型中，两种种族/民族的 CSM 和 OCM 率没有差异（危险比：0.84，P = 0.3）。在非裔美国人中，欧洲肾上腺肿瘤研究网络（ENSAT）I-II 期和 III-IV 期的 5 年 CSM 率分别为 31.2%和 75.3%，白种人分别为 32.9%和 75.4%。总体而言，非裔美国人和白种人的 5 年 OCM 率分别为 11.0%和 10.1%。与其他原发性疾病不同，在 ACC 中，非裔美国人的种族/民族与初始诊断时更高的疾病分期或更差的生存无关。
