de Angelis Mario, Jannello Letizia Maria Ippolita, Siech Carolin, Di Bello Francesco, Peñaranda Natali Rodriguez, Goyal Jordan A, Tian Zhe, Longo Nicola, de Cobelli Ottavio, Chun Felix K H, Puliatti Stefano, Saad Fred, Shariat Shahrokh F, Gandaglia Giorgio, Moschini Marco, Montorsi Francesco, Briganti Alberto, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
J Racial Ethn Health Disparities. 2024 Aug 19. doi: 10.1007/s40615-024-02131-9.
It is unknown whether race/ethnicity affects access and/or survival after neoadjuvant (NAC) or adjuvant chemotherapy (ADJ) at radical cystectomy (RC). We addressed these knowledge gaps.
Within the Surveillance, Epidemiology, and End Results database (2007-2020), we identified NAC candidates (T2-T4N0M0) and ADJ candidates (T3-T4 and/or N1-3). We focused on the four most prevalent race/ethnicities: Caucasians, Hispanics, African American (AA), and Asian/Pacific Islanders (API). Multivariable logistic regression models (MLR) tested access to NAC and ADJ. Subsequently, within NAC-exposed patients, survival analyses consisting of Kaplan-Meier plots and multivariable Cox regression models addressed CSM according to race/ethnicity were fitted. We repeated the same methodology in ADJ-exposed patients.
In 6418 NAC candidates, NAC was administered in 1011 (19.0%) Caucasians, 88 (21.0%) Hispanics, 65 (17.0%) AA, and 53 (18.0%) API. In MLR, AA exhibited lower access rates to NAC (OR 0.83, p = 0.04). In NAC-exposed patients, AA independently predicted higher CSM (HR 1.3, p < 0.001) and API independently predicted lower CSM (HR 0.83, p = 0.03). Similarly, in 5195 ADJ candidates, ADJ was administered to 1387 (33.0%) Caucasians, 100 (28.0%) Hispanics, 105 (29.0%) AA, and 90 (37.0%) API. In MLR, AA (OR 68, p = 0.003) and Hispanics (OR 0.69, p = 0.004) exhibited lower access rates to ADJ. In ADJ-exposed patients, AA independently predicted lower CSM (HR 1.32, p < 0.001), while API showed better CSM (HR 0.82, p = 0.01).
Relative to Caucasians, AA are less likely to receive either NAC or ADJ. Moreover, relative to Caucasians, AA exhibit higher CSM even when treated with either NAC or ADJ.
新辅助化疗（NAC）或辅助化疗（ADJ）后行根治性膀胱切除术（RC）时，种族/民族是否会影响治疗机会和/或生存率尚不清楚。我们填补了这些知识空白。
在监测、流行病学和最终结果数据库（2007 - 2020年）中，我们确定了NAC候选者（T2 - T4N0M0）和ADJ候选者（T3 - T4和/或N1 - 3）。我们重点关注四种最常见的种族/民族：白种人、西班牙裔、非裔美国人（AA）和亚太岛民（API）。多变量逻辑回归模型（MLR）用于测试接受NAC和ADJ的情况。随后，在接受NAC治疗的患者中，通过Kaplan - Meier曲线和多变量Cox回归模型进行生存分析，以根据种族/民族分析癌症特异性死亡率（CSM）。我们在接受ADJ治疗的患者中重复了相同的方法。
在6418名NAC候选者中，1011名（19.0%）白种人、88名（21.0%）西班牙裔、65名（17.0%）非裔美国人、53名（18.0%）亚太岛民接受了NAC。在MLR中，非裔美国人接受NAC的比率较低（比值比0.83，p = 0.04）。在接受NAC治疗的患者中，非裔美国人独立预测较高的CSM（风险比1.3，p < 0.001），而亚太岛民独立预测较低的CSM（风险比0.83，p = 0.03）。同样，在5195名ADJ候选者中，1387名（33.0%）白种人、100名（28.0%）西班牙裔、105名（29.0%）非裔美国人、90名（37.0%）亚太岛民接受了ADJ。在MLR中，非裔美国人（比值比0.68，p = 0.003）和西班牙裔（比值比0.69，p = 0.004）接受ADJ的比率较低。在接受ADJ治疗的患者中，非裔美国人独立预测较低的CSM（风险比1.32，p < 0.001），而亚太岛民的CSM情况较好（风险比0.82，p = 0.01）。
相对于白种人，非裔美国人接受NAC或ADJ的可能性较小。此外，相对于白种人，即使接受NAC或ADJ治疗，非裔美国人的CSM也较高。
