Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC, USA.
Department of Computer Science, University of North Carolina at Charlotte, Charlotte, NC, USA.
Ann Surg Oncol. 2024 Nov;31(12):8394-8404. doi: 10.1245/s10434-024-15675-1. Epub 2024 Jul 30.
Prostate cancer (PCa) is the most diagnosed noncutaneous malignancy and second leading-cause of cancer death in men, yet screening is decreasing. As PCa screening has become controversial, socioeconomic disparities in PCa diagnosis and outcomes widen. This study was designed to determine the current disparities influencing PCa diagnosis in Charlotte, NC.
The Levine Cancer Institute database was queried for patients with PCa, living in metropolitan Charlotte. Socioeconomic status (SES) was determined by the Area Deprivation Index (ADI); higher ADI indicated lower SES. Patients were compared by their National Comprehensive Cancer Network risk stratification. Artificial intelligence predictive models were trained and heatmaps were created, demonstrating the geographic and socioeconomic disparities in late-stage PCa.
Of the 802 patients assessed, 202 (25.2%) with high-risk PCa at diagnosis were compared with 198 (24.7%) with low-risk PCa. High-risk PCa patients were older (69.8 ± 9.0 vs. 64.0 ± 7.9 years; p < 0.001) with lower SES (ADI block: 98.4 ± 20.9 vs. 92.1 ± 19.8; p = 0.004) and more commonly African-American (White: 66.2% vs. 78.3%, African-American: 31.3% vs. 20.7%; p = 0.009). On regression, ADI block was an independent predictor (odds ratio [OR] = 1.013, 95% confidence interval [CI] 1.002-1.024; p = 0.024) of high-risk PCa at diagnosis, whereas race was not (OR = 1.312, 95% CI 0.782-2.201; p = 0.848). A separate regression demonstrated higher ADI (OR = 1.016, 95% CI 1.004-1.027; p = 0.006) and older age (OR = 1.083, 95% CI 1.054-1.114; p < 0.001) were independent predictors for high-risk PCa. Findings, depicted in heatmaps, demonstrated the geographic locations where men with PCa were predicted to have high-risk disease based on their age and SES.
Socioeconomic status was more closely associated with high-risk PCa at diagnosis than race. Although, of any variable, age was most predictive. The heatmaps identified areas that would benefit from increased awareness, education, and screening to facilitate an earlier PCa diagnosis.
前列腺癌（PCa）是最常见的非皮肤恶性肿瘤，也是男性癌症死亡的第二大主要原因，但筛查正在减少。随着前列腺癌筛查变得有争议，前列腺癌的诊断和结果在社会经济方面的差异也在扩大。本研究旨在确定影响北卡罗来纳州夏洛特前列腺癌诊断的当前差异。
莱文癌症研究所的数据库被查询了患有前列腺癌、居住在夏洛特大都市的患者。社会经济地位（SES）由区域剥夺指数（ADI）确定；ADI 越高表示 SES 越低。根据国家综合癌症网络风险分层对患者进行比较。训练了人工智能预测模型并创建了热图，展示了晚期前列腺癌在地理和社会经济方面的差异。
在评估的 802 名患者中，对 202 名（25.2%）初诊为高危前列腺癌的患者与 198 名（24.7%）低危前列腺癌患者进行了比较。高危前列腺癌患者年龄更大（69.8±9.0 岁比 64.0±7.9 岁；p<0.001），SES 更低（ADI 块：98.4±20.9 比 92.1±19.8；p=0.004），且更常见的是非裔美国人（白人：66.2%比 78.3%，非裔美国人：31.3%比 20.7%；p=0.009）。回归分析显示，ADI 块是诊断为高危前列腺癌的独立预测因素（优势比[OR]1.013，95%置信区间[CI]1.002-1.024；p=0.024），而种族不是（OR 1.312，95%CI 0.782-2.201；p=0.848）。另一项回归分析表明，较高的 ADI（OR 1.016，95%CI 1.004-1.027；p=0.006）和较高的年龄（OR 1.083，95%CI 1.054-1.114；p<0.001）是高危前列腺癌的独立预测因素。热图显示了根据年龄和 SES 预测患有前列腺癌的男性存在高危疾病的地理位置。
社会经济地位与初诊时的高危前列腺癌更为密切相关，而不是种族。尽管年龄是最具预测性的因素。热图确定了需要提高认识、教育和筛查的区域，以促进更早的前列腺癌诊断。
