Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
JNCI Cancer Spectr. 2024 Jul 1;8(4). doi: 10.1093/jncics/pkae061.
Mechanisms underlying racial and ethnic disparities in robot-assisted radical prostatectomy (RARP) vs open radical prostatectomy (ORP) are unclear. We sought to test 2 physician-level hypotheses: 1) Segregated Treatment and 2) Differential Treatment.
This observational study used the New York State Cancer Registry linked to discharge records and included patients undergoing radical prostatectomy for localized prostate cancer from October 1, 2008 to December 31, 2018. For hypothesis 1, we examined the association between patient race and ethnicity and treating surgeon RARP use (high-use surgeons, low-use surgeons, and surgeons at non-RARP facilities). For hypothesis 2, we determined the association between patient race and ethnicity and receipt of RARP when matching on treating surgeon, age, year of procedure, and Gleason group. We explored the role of insurance in both analyses.
This study included 18 926 patients (8.0% Hispanic, 16.9% non-Hispanic Black, 75.1% non-Hispanic White), with a mean age of 60.4 ± 7.1 years. Compared with non-Hispanic White patients, Hispanic and non-Hispanic Black patients had higher odds of being treated by low-RARP-use surgeons (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.20 to 3.88; OR = 1.76, 95% CI = 1.06 to 2.94, respectively) and by surgeons at non-RARP facilities (OR = 4.19, 95% CI = 2.18 to 8.07; OR = 4.60, 95% CI = 2.58 to 8.23, respectively). In the matched cohorts, Hispanic and non-Hispanic Black patients were less likely to receive RARP than non-Hispanic White patients (OR = 0.78, 95% CI = 0.62 to 0.98; OR = 0.75, 95% CI = 0.57 to 1.00, respectively). These associations were partially attenuated after accounting for insurance.
Racial and ethnic disparities in RARP use are related to patients being treated by different surgeons and treated differently by the same surgeons. Identifying and addressing multilevel barriers to equitable surgical treatment is needed to reduce disparities among prostate cancer patients.
机器人辅助根治性前列腺切除术（RARP）与开放根治性前列腺切除术（ORP）中种族和民族差异的机制尚不清楚。我们试图检验两个医生层面的假设：1）隔离治疗和 2）差异治疗。
这项观察性研究使用了纽约州癌症登记处，与出院记录相关联，并包括 2008 年 10 月 1 日至 2018 年 12 月 31 日期间因局限性前列腺癌接受根治性前列腺切除术的患者。对于假设 1，我们检查了患者种族和民族与治疗外科医生 RARP 使用之间的关联（高使用外科医生、低使用外科医生和非 RARP 设施的外科医生）。对于假设 2，我们在匹配治疗外科医生、年龄、手术年份和 Gleason 组的基础上，确定了患者种族和民族与接受 RARP 之间的关联。我们探讨了保险在这两个分析中的作用。
这项研究包括 18926 名患者（8.0%为西班牙裔，16.9%为非西班牙裔黑人，75.1%为非西班牙裔白人），平均年龄为 60.4±7.1 岁。与非西班牙裔白人患者相比，西班牙裔和非西班牙裔黑人患者更有可能接受低 RARP 使用率外科医生的治疗（优势比[OR]为 2.16，95%置信区间[CI]为 1.20 至 3.88；OR 为 1.76，95%CI 为 1.06 至 2.94）和非 RARP 设施的外科医生（OR 为 4.19，95%CI 为 2.18 至 8.07；OR 为 4.60，95%CI 为 2.58 至 8.23）。在匹配队列中，西班牙裔和非西班牙裔黑人患者接受 RARP 的可能性低于非西班牙裔白人患者（OR 为 0.78，95%CI 为 0.62 至 0.98；OR 为 0.75，95%CI 为 0.57 至 1.00）。这些关联在考虑到保险后部分减弱。
RARP 使用中的种族和民族差异与患者接受不同外科医生治疗以及同一外科医生的不同治疗有关。需要确定和解决公平手术治疗的多层次障碍，以减少前列腺癌患者的差异。
