de Angelis Mario, Siech Carolin, Jannello Letizia Maria Ippolita, Di Bello Francesco, Peñaranda Natali Rodriguez, Scilipoti Pietro, Goyal Jordan A, Tian Zhe, Longo Nicola, de Cobelli Ottavio, Musi Gennaro, Chun Felix K H, Micali Salvatore, 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, Québec, Canada.
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
J Racial Ethn Health Disparities. 2025 Jul 11. doi: 10.1007/s40615-025-02544-0.
It is unknown whether race/ethnicity affects the risk of secondary bladder cancer (BCa) or rectal cancer (RCa) after external beam radiation therapy (EBRT) or brachytherapy (BT) for prostate cancer (PCa).
Within the Surveillance, Epidemiology, and End Results database (2004-2020), we focused on Caucasians, Hispanics, African Americans (AAs), and Asian/Pacific Islanders (APIs). Cumulative incidence plots and competing risks regression (CRR) models were fitted. We tested for secondary BCa and RCa rates after either EBRT or BT relative to radical prostatectomy (RP) patients, in whom no radiation therapy was used. Additionally, we performed an interaction analysis to assess whether the effect of radiation therapy on secondary malignancy risk differed across racial groups.
Of 285,859 patients, 202,421 (71%) were Caucasians, 41,719 (15%) AAs, 26,705 (9%) Hispanics, and 15,014 (5%) APIs. After EBRT, secondary BCa increase was HR 1.4 in Caucasians, HR 1.7 in AAs, HR 2.1 in APIs, and HR 2.2 in Hispanics relative to radiation-unexposed RP patients. Similarly, after BT, secondary BCa increase was HR 1.5 in Caucasians, HR 1.7 in AAs, HR 2.3 in APIs, and HR 2.4 in Hispanics. Regarding RCa, after EBRT, secondary RCa increase was HR 1.5 in Caucasians and HR 1.3 in both AAs and Hispanics. Similarly, after BT, relative secondary RCa increase was HR 1.4 in Caucasians and HR 1.5 in both AAs and Hispanics. No increase was recorded in APIs after EBRT (p = 0.09) either BT (p = 0.7). Finally, the interaction analysis were inconclusive whether the relative effect of EBRT/BT differ between races, while it suggested a baseline difference in the risk of secondary tumor between Caucasian and non-Caucasian race/ethnicities.
Radiation exposure does not result in major differences dictated by race or ethnicity when secondary BCa and RCa are considered, as the relative risk increase appears consistent across racial groups. Conversely, it appears that baseline risk (independent of radiation therapy) is inherently lower in non-Caucasian populations.
对于接受前列腺癌（PCa）外照射放疗（EBRT）或近距离放疗（BT）后发生继发性膀胱癌（BCa）或直肠癌（RCa）的风险是否受种族/族裔影响尚不清楚。
在监测、流行病学和最终结果数据库（2004 - 2020年）中，我们重点关注了白种人、西班牙裔、非裔美国人（AA）和亚裔/太平洋岛民（API）。拟合了累积发病率图和竞争风险回归（CRR）模型。我们测试了EBRT或BT后相对于未接受放疗的根治性前列腺切除术（RP）患者的继发性BCa和RCa发生率。此外，我们进行了交互分析，以评估放疗对继发性恶性肿瘤风险的影响在不同种族群体中是否存在差异。
在285,859名患者中，202,421名（71%）为白种人，41,719名（15%）为非裔美国人，26,705名（9%）为西班牙裔，15,014名（5%）为亚裔/太平洋岛民。EBRT后，相对于未接受放疗的RP患者，白种人继发性BCa增加的风险比（HR）为1.4，非裔美国人为1.7，亚裔/太平洋岛民为2.1，西班牙裔为2.2。同样，BT后，白种人继发性BCa增加的HR为1.5，非裔美国人为1.7，亚裔/太平洋岛民为2.3，西班牙裔为2.4。关于RCa，EBRT后，白种人继发性RCa增加的HR为1.5，非裔美国人和西班牙裔均为1.3。同样，BT后，白种人继发性RCa相对增加的HR为1.4，非裔美国人和西班牙裔均为1.5。EBRT后亚裔/太平洋岛民未观察到增加（p = 0.09），BT后也未增加（p = 0.7）。最后，交互分析对于EBRT/BT的相对效应在不同种族之间是否存在差异尚无定论，不过提示白种人与非白种人种族/族裔之间继发性肿瘤风险存在基线差异。
当考虑继发性BCa和RCa时，辐射暴露不会导致由种族或族裔决定的重大差异，因为相对风险增加在不同种族群体中似乎是一致的。相反，非白种人群的基线风险（与放疗无关）似乎天生较低。
