Adesanya Oluwafolajimi, Rojanasarot Sirikan, McGovern Alysha M, Burnett Arthur L
Department of Urology, James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA.
Boston Scientific Marlborough Massachusetts USA.
BJUI Compass. 2024 Feb 29;5(6):564-575. doi: 10.1002/bco2.342. eCollection 2024 Jun.
To investigate the racial and socioeconomic (income) differences in receipt of and time to surgical care for urinary incontinence (UI) and erectile dysfunction (ED) occurring post-radical prostatectomy (RP) and/or radiation therapy (RT).
Utilizing the Medicare Standard Analytical Files (SAF), a retrospective cohort study was performed on data of patients diagnosed with prostate cancer (PCa) from 2015 to 2021. Patients who underwent RP and/or RT and who subsequently developed UI and/or ED were grouped into four cohorts: RP-ED, RP-UI, RT-ED and RT-UI. County-level median household income was cross-referenced with SAF county codes, classified into income quartiles, and used as a proxy for patient income status. The rate of surgical care was compared between groups using two-sample t-test and log-rank test. Cox proportional hazards modelling was used to determine covariate-adjusted impact of race on time to surgical care.
The rate of surgical care was 6.8, 3.61 3.07, and 1.54 per 100 person-years for the RP-UI, RT-UI, RP-ED, and RT-ED cohorts, respectively. Cox proportional regression analysis revealed that Black men were statistically more likely to receive ED surgical care (RP-ED AHR:1.79, 95% CI:1.49-2.17; RT-ED AHR:1.50, 95% CI:1.11-2.01), but less likely to receive UI surgical care (RP-UI AHR:0.80, 95% CI:0.67-0.96) than White men, in all cohorts except RT-UI. Surgical care was highest among Q1 (lowest income quartile) patients in all cohorts except RT-UI.
Surgical care for post-PCa treatment complications is low, and significantly impacted by racial and socioeconomic (income) differences. Prospective studies investigating the basis of these results would be insightful.
研究根治性前列腺切除术（RP）和/或放射治疗（RT）后发生尿失禁（UI）和勃起功能障碍（ED）时，接受手术治疗的情况以及手术时间上的种族和社会经济（收入）差异。
利用医疗保险标准分析文件（SAF），对2015年至2021年诊断为前列腺癌（PCa）的患者数据进行回顾性队列研究。接受RP和/或RT且随后出现UI和/或ED的患者被分为四个队列：RP-ED、RP-UI、RT-ED和RT-UI。将县级家庭收入中位数与SAF县代码进行交叉参考，分为收入四分位数，并用作患者收入状况的替代指标。使用双样本t检验和对数秩检验比较各组之间的手术治疗率。采用Cox比例风险模型确定种族对手术治疗时间的协变量调整影响。
RP-UI、RT-UI、RP-ED和RT-ED队列的手术治疗率分别为每100人年6.8、3.61、3.07和1.54。Cox比例回归分析显示，在除RT-UI之外的所有队列中，黑人男性接受ED手术治疗的可能性在统计学上高于白人男性（RP-ED风险比：1.79，95%置信区间：1.49-2.17；RT-ED风险比：1.50，95%置信区间：1.11-2.01），但接受UI手术治疗的可能性低于白人男性（RP-UI风险比：0.80，95%置信区间：0.67-0.96）。在除RT-UI之外的所有队列中，Q1（收入最低四分位数）患者的手术治疗率最高。
PCa治疗后并发症的手术治疗率较低，且受到种族和社会经济（收入）差异的显著影响。对这些结果的基础进行前瞻性研究将具有深刻意义。
