Zagars G K, Pollack A, Pettaway C A
Department of Radiation Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 1998 Oct 1;42(3):517-23. doi: 10.1016/s0360-3016(98)00260-0.
To compare the outcome of irradiated clinically localized prostate cancer in African-American and white patients.
This was a retrospective review of 1,201 men, 116 African-American and 1,085 white, with T1-T3, N0/NX, M0 prostate cancer receiving external radiation between 1987 and 1996. Pretreatment characteristics, treatment parameters, and outcome (relapse or rising prostate-specific antigen [PSA] levels, local recurrence, metastatic relapse, and survival) were compared between the groups using univariate and multivariate statistical methods.
There were no significant differences between African-American and white patients in T-stage, Gleason score, prostatic acid phosphatase (PAP) level, and testosterone level. African-Americans had a significantly lower incidence of abnormal digital rectal findings and a proportionally higher incidence of obstructive urinary symptoms at presentation and tended to be somewhat younger. A major difference between the two groups was in the significantly higher PSA levels among African-Americans (median, 14 ng/ml) than among white patients (median, 9.5 ng/ml). This translated into a higher incidence of unfavorable disease according to our criteria (39% vs. 25%) among African-Americans and, thus, to the more frequent use of adjuvant androgen ablation and to somewhat higher radiation doses in these patients. With a median follow-up of 42 months the overall 6-year freedom from relapse for African-Americans was 63% compared to 61% for whites (p = 0.634). We found no significant differences in biochemical relapse rates between any subgroups of African-Americans and whites. Specifically, even patients who did not have androgen ablation, when stratified by PSA levels, had similar outcomes regardless of race. Likewise, local recurrence and metastasis rates were not significantly different between the two groups.
Although African-American patients tend to have higher pretreatment PSA levels than white patients, the outcome for the disease is similar in the two groups when stratified by known pretreatment prognostic factors. Our data provide no evidence for the hypothesis that prostate cancer in African-Americans is intrinsically more virulent than in whites.
比较非裔美国人和白人患者中接受放疗的临床局限性前列腺癌的治疗结果。
这是一项对1201名男性患者的回顾性研究，其中116名是非裔美国人，1085名是白人，他们患有T1 - T3期、N0/NX、M0期前列腺癌，于1987年至1996年间接受了外照射。使用单变量和多变量统计方法比较两组患者的治疗前特征、治疗参数以及治疗结果（复发或前列腺特异性抗原[PSA]水平升高、局部复发、远处转移复发和生存率）。
非裔美国人和白人患者在T分期、Gleason评分、前列腺酸性磷酸酶（PAP）水平和睾酮水平方面没有显著差异。非裔美国人直肠指检异常的发生率显著较低，就诊时梗阻性尿路症状的发生率相对较高，且年龄往往稍小。两组之间的一个主要差异是，非裔美国人的PSA水平（中位数为14 ng/ml）显著高于白人患者（中位数为9.5 ng/ml）。根据我们的标准，这导致非裔美国人中不良疾病的发生率更高（39%对25%），因此这些患者更频繁地使用辅助性雄激素剥夺治疗，并且放疗剂量也稍高。中位随访42个月时，非裔美国人的总体6年无复发生存率为63%，而白人为61%（p = 0.634）。我们发现非裔美国人和白人的任何亚组之间生化复发率没有显著差异。具体而言，即使未接受雄激素剥夺治疗的患者，按PSA水平分层后，无论种族，其治疗结果相似。同样，两组之间的局部复发率和转移率也没有显著差异。
尽管非裔美国患者治疗前的PSA水平往往高于白人患者，但根据已知的治疗前预后因素进行分层时，两组疾病的治疗结果相似。我们的数据没有为非裔美国人前列腺癌本质上比白人更具侵袭性这一假设提供证据。
