Sindhu Kunal K, Dovey Zachary, Thompson Marcher, Nehlsen Anthony D, Skalina Karin A, Malachowska Beata, Hasan Shaakir, Guha Chandan, Tang Justin, Salgado Lucas Resende
Department of Radiation Oncology Icahn School of Medicine at Mount Sinai New York NY USA.
Department of Urology Icahn School of Medicine at Mount Sinai New York NY USA.
BJUI Compass. 2024 Feb 8;5(4):405-425. doi: 10.1002/bco2.323. eCollection 2024 Apr.
Racial disparities in oncological outcomes resulting from differences in social determinants of health (SDOH) and tumour biology are well described in prostate cancer (PCa) but similar inequities exist in bladder (BCa) and renal cancers (RCCs). Precision medicine (PM) aims to provide personalized treatment based on individual patient characteristics and has the potential to reduce these inequities in GU cancers.
This article aims to review the current evidence outlining racial disparities in GU cancers and explore studies demonstrating improved oncological outcomes when PM is applied to racially diverse patient populations.
Evidence was obtained from Pubmed and Web of Science using keywords prostate, bladder and renal cancer, racial disparity and precision medicine. Because limited studies were found, preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were not applied but rather related articles were studied to explore existing debates, identify the current status and speculate on future applications.
Evidence suggests addressing SDOH for PCa can reverse racial inequities in oncological outcomes but differences in incidence remain. Similar disparities in BCa and RCC are seen, and it would be reasonable to suggest achieving parity in SDOH for all races would do the same. Research applying a PM approach to different ethnicities is lacking although in African Americans (AAs) with metastatic castrate-resistant prostate cancer (mCRPCa) better outcomes have been shown with androgen receptor inhibitors, radium-223 and sipuleucel. Exploiting the abscopal effect with targeted radiation therapy (RT) and immunotherapy has promise but requires further study, as does defining actionable mutations in specific patient groups to tailor treatments as appropriate.
For all GU cancers, the historical underrepresentation of ethnic minorities in clinical trials still exists and there is an urgent need for recruitment strategies to address this. PM is a promising development with the potential to reduce inequities in GU cancers, however, both improved understanding of race-specific tumour biology, and enhanced recruitment of minority populations into clinical trials are required. Without this, the benefits of PM will be limited.
前列腺癌（PCa）中因健康的社会决定因素（SDOH）和肿瘤生物学差异导致的肿瘤学结局种族差异已有详尽描述，但膀胱癌（BCa）和肾癌（RCC）中也存在类似的不平等现象。精准医学（PM）旨在根据个体患者特征提供个性化治疗，有潜力减少泌尿生殖系统癌症中的这些不平等现象。
本文旨在综述当前概述泌尿生殖系统癌症种族差异的证据，并探讨将精准医学应用于不同种族患者群体时显示出改善肿瘤学结局的研究。
通过在PubMed和Web of Science上使用关键词前列腺癌、膀胱癌和肾癌、种族差异和精准医学来获取证据。由于发现的研究有限，未应用系统评价和Meta分析的首选报告项目（PRISMA）指南，而是研究相关文章以探讨现有争议、确定当前状况并推测未来应用。
有证据表明，解决前列腺癌的SDOH问题可扭转肿瘤学结局中的种族不平等现象，但发病率差异依然存在。在膀胱癌和肾癌中也观察到类似差异，可以合理推测，实现所有种族在SDOH方面的平等也会产生同样效果。尽管在转移性去势抵抗性前列腺癌（mCRPCa）的非裔美国人（AA）中，雄激素受体抑制剂、镭-223和西妥昔单抗已显示出更好的结局，但缺乏将精准医学方法应用于不同种族的研究。利用靶向放射治疗（RT）和免疫疗法的远隔效应有前景，但需要进一步研究，为特定患者群体确定可操作的突变以进行适当的治疗定制也是如此。
对于所有泌尿生殖系统癌症，少数族裔在临床试验中的代表性不足这一历史问题仍然存在，迫切需要招募策略来解决这一问题。精准医学是一项有前景的进展，有潜力减少泌尿生殖系统癌症中的不平等现象，然而，需要更好地理解种族特异性肿瘤生物学，并加强将少数族裔人群纳入临床试验。没有这些，精准医学的益处将受到限制。
