Viganò Silvia, Finati Marco, Stephens Alex, Bertini Alessandro, Finocchiaro Alessio, Lughezzani Giovanni, Buffi Nicolò, Salonia Andrea, Briganti Alberto, Montorsi Francesco, Rossanese Marta, Di Trapani Ettore, Ficarra Vincenzo, Sood Akshay, Rogers Craig, Abdollah Firas
VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, Michigan, USA.
Department of Human and Pediatric Pathology Gaetano Barresi, Section of Urology, Messina, Italy.
Prostate. 2025 Jun;85(8):758-766. doi: 10.1002/pros.24882. Epub 2025 Mar 11.
Socioeconomic status and geographical location contribute to disparities in localized prostate cancer (PCa) treatment. We examined the impact of area of deprivation index (ADI) on initial treatment type for localized PCa in a North-American cohort.
We performed a retrospective analysis of patients diagnosed with localized PCa, treated within Henry Ford Health (HFH), between 1995 and 2022, with available ADI-data. ADI was assigned based on residential census block group, ranked as a national deprivation percentile. Patients were categorized into three treatment-groups: radical prostatectomy (RP), radiation therapy (RT) and "other" treatment. Using multinomial logistic regression, we assessed ADI impact on treatment choice. After excluding patients without cT, ISUP-grade and/or PSA, we stratified by D'Amico risk-classification and repeated the regression analysis in each subgroup.
Among 14,204 patients, 28.4% were NHB. Median (IQR) age at diagnosis was 65 (59-71) years. Median (IQR) ADI was 58 (36-83) for overall cohort and 51 (30-74), 66 (45-91), and 62 (39-88) for RP, RT, and "other" groups, respectively (p < 0.0001). Multivariable analysis showed ADI as an independent predictor of treatment choice (p = 0.01): for each 10-unit increase in ADI, patients were 3% more likely to receive RT and 10% less likely to receive RP. High ADI predicted a lower likelihood of receiving initial surgery across all risk-groups (p < 0.001).
Patients in more advantaged areas were more likely to receive RP, while those in disadvantaged areas received more RT. Recognizing how neighborhood factors affect treatment choices is crucial for improving health equity and reducing disparities in PCa outcomes.
社会经济地位和地理位置导致局部前列腺癌（PCa）治疗存在差异。我们研究了贫困指数（ADI）对北美队列中局部PCa初始治疗类型的影响。
我们对1995年至2022年间在亨利·福特健康中心（HFH）接受治疗且有可用ADI数据的局部PCa患者进行了回顾性分析。ADI根据居住人口普查街区组进行分配，按全国贫困百分位数排名。患者被分为三个治疗组：根治性前列腺切除术（RP）、放射治疗（RT）和“其他”治疗。使用多项逻辑回归，我们评估了ADI对治疗选择的影响。在排除没有cT、ISUP分级和/或PSA的患者后，我们按达米科风险分类进行分层，并在每个亚组中重复回归分析。
在14204例患者中，28.4%为非西班牙裔黑人（NHB）。诊断时的中位（IQR）年龄为65（59 - 71）岁。整个队列的中位（IQR）ADI为58（36 - 83），RP组、RT组和“其他”组分别为51（30 - 74）、66（45 - 91）和62（39 - 88）（p < 0.0001）。多变量分析显示ADI是治疗选择的独立预测因素（p = 0.01）：ADI每增加10个单位，患者接受RT的可能性增加3%，接受RP的可能性降低10%。高ADI预测所有风险组接受初始手术的可能性较低（p < 0.001）。
处于更有利地区的患者更有可能接受RP，而处于不利地区的患者接受更多的RT。认识到邻里因素如何影响治疗选择对于改善健康公平性和减少PCa治疗结果的差异至关重要。
