Department of Urology, Aerospace Center Hospital, Beijing, China.
Peking University Aerospace School of Clinical Medicine, Beijing, China.
BMC Urol. 2023 Jul 18;23(1):122. doi: 10.1186/s12894-023-01293-8.
Traditional estimates can only provide static predictions of cancer outcomes and cannot assess the evolving effect of race on patient survival. This study aims to reveal the dynamic survival of patients with bladder cancer and to explore the evolving effect of race on patient prognosis.
Using data from the Surveillance, Epidemiology, and End Results (SEER) registry, 99,590 white, 6,036 African American, and 4,685 Asian/Pacific Islander (API) patients with bladder cancer were identified. Conditional cancer-specific survival (CSS) rates, which could reflect the dynamic survival prediction of cancer patients, represented the primary outcomes, and were estimated by the Kaplan-Meier algorithm. The evolving effect of race on patient survival was evaluated by multivariable Cox regression in combination with conditional survival (CS) estimates.
The 5-year CSS for African American patients who had survived 1, 2, 3, 4, or 5 years after definitive therapy improved from the baseline calculation by + 5.8 (84.4%), + 9.5 (87.4%), + 12.8 (90.0%), + 14.4 (91.3%), and + 14.7% (91.5%), respectively. The increasing trend also held for overall white and API patients, and for all patient subsets when CS was calculated according to different levels of sex, age, and disease stage. African Americans, despite having the worst survival at baseline, could have CSS comparable to their white and API counterparts after 4 years of survivorship. In addition, the risk of death for African Americans tended to decrease with increasing survival, and the risk was no longer significantly different from that of whites after 4 years of survival.
While having the worst initial predicted outcomes, African Americans may eventually achieve comparable survival to white and API patients given several years of survivorship. As patient survival increases, African American race may lose its role as an indicator of poorer prognosis.
传统的估计方法只能提供癌症结局的静态预测，无法评估种族对患者生存的不断变化的影响。本研究旨在揭示膀胱癌患者的动态生存情况，并探讨种族对患者预后的不断变化的影响。
利用监测、流行病学和最终结果（SEER）登记处的数据，确定了 99590 名白人、6036 名非裔美国人和 4685 名亚洲/太平洋岛民（API）膀胱癌患者。条件癌症特异性生存率（CSS）反映了癌症患者的动态生存预测，是主要结局，通过 Kaplan-Meier 算法进行估计。通过多变量 Cox 回归结合条件生存（CS）估计来评估种族对患者生存的不断变化的影响。
接受根治性治疗后存活 1、2、3、4 或 5 年的非裔美国患者的 5 年 CSS 从基线计算提高了+5.8（84.4%）、+9.5（87.4%）、+12.8（90.0%）、+14.4（91.3%）和+14.7%（91.5%）。对于所有白人患者和 API 患者，以及根据性别、年龄和疾病分期的不同水平计算 CS 时的所有患者亚组，均观察到这种增加趋势。尽管非裔美国人的生存状况最差，但在 4 年的生存后，他们的 CSS 可能与他们的白人患者和 API 患者相当。此外，随着生存时间的延长，非裔美国人的死亡风险呈下降趋势，在 4 年的生存后，死亡风险与白人患者不再有显著差异。
尽管非裔美国人最初的预测结局最差，但如果有几年的生存时间，他们最终可能会获得与白人患者和 API 患者相当的生存。随着患者生存时间的延长，非裔美国人的种族可能不再是预后较差的指标。
