Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Prostate. 2023 Aug;83(11):1099-1111. doi: 10.1002/pros.24552. Epub 2023 May 7.
Racial and ethnic disparities in prostate cancer (PCa) mortality are partially mediated by inequities in quality of care. Intermediate- and high-risk PCa can be treated with either surgery or radiation, therefore we designed a study to assess the magnitude of race-based differences in cancer-specific survival between these two treatment modalities.
Non-Hispanic Black (NHB) and non-Hispanic White (NHW) men with localized intermediate- and high-risk PCa, treated with surgery or radiation between 2004 and 2015 in the Surveillance, Epidemiology and End Results database were included in the study and followed until December 2018. Unadjusted and adjusted survival analyses were employed to compare cancer-specific survival by race and treatment modality. A model with an interaction term between race and treatment was used to assess whether the type of treatment amplified or attenuated the effect of race/ethnicity on prostate cancer-specific mortality (PCSM).
15,178 (20.1%) NHB and 60,225 (79.9%) NHW men were included in the study. NHB men had a higher cumulative incidence of PCSM (p = 0.005) and were significantly more likely to be treated with radiation than NHW men (aOR: 1.89, 95% CI: 1.81-1.97, p < 0.001). In the adjusted models, NHB men were significantly more likely to die from PCa compared with NHW men (aHR: 1.18, 95% CI: 1.03-1.35, p = 0.014), and radiation was associated with a significantly higher odds of PCSM (aHR: 2.10, 95% CI: 1.85-2.38, p < 0.001) compared with surgery. Finally, the interaction between race and treatment on PCSM was not significant, meaning that no race-based differences in PCSM were found within each treatment modality.
NHB men with intermediate- and high-risk PCa had a higher rate of PCSM than NWH men in a large national cancer registry, though NHB and NHW men managed with the same treatment achieved similar PCa survival outcomes. The higher tendency for NHB men to receive radiation was similar in magnitude to the difference in cancer survival between racial and ethnic groups.
前列腺癌（PCa）死亡率的种族和民族差异部分是由护理质量的不平等造成的。中高危 PCa 可以通过手术或放疗进行治疗，因此我们设计了一项研究来评估这两种治疗方法之间基于种族的癌症特异性生存率差异的程度。
本研究纳入了 2004 年至 2015 年期间在监测、流行病学和最终结果数据库中接受手术或放疗治疗的局部中高危 PCa 的非西班牙裔黑人（NHB）和非西班牙裔白人（NHW）男性，并随访至 2018 年 12 月。采用未调整和调整后的生存分析比较种族和治疗方式的癌症特异性生存率。采用包含种族和治疗相互作用项的模型来评估治疗方式是否放大或减弱了种族/民族对前列腺癌特异性死亡率（PCSM）的影响。
研究纳入了 15178 名（20.1%）NHB 和 60225 名（79.9%）NHW 男性。与 NHW 男性相比，NHB 男性的 PCSM 累积发生率更高（p=0.005），且更有可能接受放疗治疗（aOR：1.89，95%CI：1.81-1.97，p<0.001）。在调整后的模型中，与 NHW 男性相比，NHB 男性死于 PCa 的可能性显著更高（aHR：1.18，95%CI：1.03-1.35，p=0.014），与手术相比，放疗与 PCSM 的发生几率显著更高（aHR：2.10，95%CI：1.85-2.38，p<0.001）。最后，种族和治疗方式对 PCSM 的交互作用不显著，这意味着在每种治疗方式中都没有发现基于种族的 PCSM 差异。
在一个大型国家癌症登记处，与 NHW 男性相比，中高危 PCa 的 NHB 男性的 PCSM 发生率更高，尽管接受相同治疗的 NHB 和 NHW 男性获得了相似的 PCa 生存结果。NHB 男性接受放疗的倾向较高，与种族和民族群体之间的癌症生存率差异相当。
