在平等医疗体系中比较黑人和白人患者晚期前列腺癌的治疗及生存情况

Comparing Black and White Patients in Treatment of Advanced Prostate Cancer and Survival in an Equal Access Health System.

作者信息

Eaglehouse Yvonne L, Darmon Sarah, Chesnut Gregory T, Shriver Craig D, Zhu Kangmin

机构信息

Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences (USUHS), 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA.

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.

出版信息

J Racial Ethn Health Disparities. 2024 Oct 21. doi: 10.1007/s40615-024-02217-4.

DOI:10.1007/s40615-024-02217-4

PMID:39433656

Abstract

BACKGROUND

Racial disparities in prostate cancer treatment and survival in the U.S. have been attributed to differences in access to care and medical insurance. We aimed to compare treatment and survival of advanced prostate cancers between White and Black men in the equal access Military Health System (MHS).

METHODS

We accessed the MilCanEpi database to study a cohort of non-Hispanic White and Black men diagnosed with stage III or IV prostate cancer between 1998 and 2014 in the MHS. The racial groups were compared in receiving curative treatment of radical prostatectomy (RP) only, RP with (neo)adjuvant radiation or hormone therapy, radiation only, or combination radiation and hormone therapy; and overall survival using multivariable regression models.

RESULTS

The study included 1476 White and 531 Black men. Overall, there was no racial difference in receiving any curative treatment (AOR = 0.85, 95% CI = 0.67, 1.08 for Black vs. White). By treatment type, Black men were statistically as likely to receive RP only (AOR = 0.87, 95% CI = 0.67, 1.14), radiation only (AOR = 0.81, 95% CI = 0.49, 1.34), or combination radiation and hormone therapy (AOR = 1.12, 95% CI = 0.71, 1.78) but statistically less likely to receive RP with (neo)adjuvant treatment (AOR = 0.56, 95% CI = 0.37, 0.86) relative to no curative treatment compared to White men. The difference in RP with (neo)adjuvant treatment was also statistically significant among patients with stage III tumors, but not stage IV. Survival was similar overall (AHR = 1.12, 95% CI = 0.88, 1.42 for Black vs. White) and when evaluated by tumor stage.

CONCLUSIONS

In the MHS, the overall likelihood to receive any treatment for advanced prostate cancers and survival was similar between races, which might result from universal health care. Racial differences in receipt of RP with (neo)adjuvant treatment, especially for patients with stage III prostate cancer, may be related to factors other than access to care and warrants further research.

摘要

背景

美国前列腺癌治疗和生存方面的种族差异归因于医疗服务可及性和医疗保险的差异。我们旨在比较在医疗服务可及性平等的军事医疗系统（MHS）中，白人和黑人男性晚期前列腺癌的治疗和生存情况。

方法

我们访问了MilCanEpi数据库，以研究1998年至2014年期间在MHS中被诊断为III期或IV期前列腺癌的非西班牙裔白人和黑人男性队列。比较了不同种族在仅接受前列腺癌根治术（RP）的根治性治疗、RP联合（新）辅助放疗或激素治疗、仅放疗或放疗与激素治疗联合；以及使用多变量回归模型比较总体生存率方面的情况。

结果

该研究纳入了1476名白人男性和531名黑人男性。总体而言，在接受任何根治性治疗方面没有种族差异（黑人与白人相比，调整优势比[AOR]=0.85，95%置信区间[CI]=0.67，1.08）。按治疗类型划分，黑人男性接受仅RP治疗（AOR=0.87，95%CI=0.67，1.14）、仅放疗（AOR=0.81，95%CI=0.49，1.34）或放疗与激素治疗联合（AOR=1.12，95%CI=0.71，1.78）的可能性在统计学上与白人相似，但与未接受根治性治疗的白人男性相比，接受RP联合（新）辅助治疗的可能性在统计学上较低（AOR=0.56，95%CI=0.37，0.86）。在III期肿瘤患者中，RP联合（新）辅助治疗的差异在统计学上也很显著，但在IV期患者中不显著。总体生存率相似（黑人与白人相比，调整风险比[AHR]=1.12，95%CI=0.88，1.42），按肿瘤分期评估时也是如此。