Explaining the race difference in prostate cancer stage at diagnosis
Explaining the race difference in prostate cancer stage at diagnosis
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DOI：
10.1158/1055-9965.epi-08-0203
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发表时间：
2008-10-01
影响因子：
3.8
通讯作者：
Dubrow, Robert
中科院分区：
文献类型：
--
作者：
Jones, Beth A.;Liu, Wen-Liang;Dubrow, Robert
前列腺癌是美国男性中最常诊断出的癌症，估计 2008 年新增病例为 186,320 例。美国前列腺癌的发病率和死亡率存在显着的种族或民族差异，黑人男性被诊断出前列腺癌的可能性是白人的 1.6 倍，死于前列腺癌的可能性是白人的 2.4 倍。诊断分期是前列腺癌生存的关键预后因素，非裔美国人通常在更晚期被诊断出来。为了确定解释前列腺癌种族阶段差异的因素，我们对 1987 年 1 月至 1990 年 10 月期间在康涅狄格州诊断的 251 名非裔美国人 (46%) 和白人 (54%) 前列腺癌病例进行了一项基于人群的病例研究。使用多变量逻辑回归来确定潜在的解释因素，包括临床、社会人口、医疗保健、保险、直肠指检筛查历史和生活方式因素。 Cox 比例风险模型评估了研究变量对长期生存的种族差异的影响。筛查实践和社会人口统计学因素等可改变的因素导致诊断时前列腺癌分期的种族差异超过 60%。组织学分级（Gleason评分）所占比例相对较少。生存分析证实了肿瘤特征、教育和保险在解释观察到的生存种族差异方面的重要性。尽管病例是在广泛使用前列腺特异性抗原（PSA）筛查之前发现的，但结果也应该与大量人口服务不足和/或在获得医疗保健和癌症筛查方面存在差异的国家相关。
Prostate cancer is the most frequently diagnosed cancer in males in the United States, accounting for an estimated 186,320 new cases in 2008. There are striking racial or ethnic differences in prostate cancer incidence and mortality rates in the United States, with Black males 1.6 times more likely to be diagnosed and 2.4 times more likely to die with prostate cancer than Whites. Stage at diagnosis is a key prognostic factor for prostate cancer survival, with African-Americans generally diagnosed at a more advanced stage. To identify factors that explain the race-stage disparity in prostate cancer, we conducted a population-based case-case study of 251 African-American (46%) and White (54%) prostate cancer cases diagnosed in Connecticut between January 1987 and October 1990. Multivariate logistic regression was used to identify potential explanatory factors, including clinical, sociodemographic, medical care, insurance, digital rectal examination screening history, and lifestyle factors. Cox proportional hazards models assessed the impact of study variables on race differences in long-term survival. Modifiable factors such as screening practice and sociodemographic factors accounted for > 60% of the race difference in prostate cancer stage at diagnosis. Histologic grade (Gleason score) accounted for comparatively less. Survival analyses confirmed the importance of tumor characteristics, education, and insurance in explaining observed race differences in survival. Although cases were identified before the widespread use of prostate-specific antigen (PSA) screening, the results should also be relevant to countries that have large underserved populations and/or disparities in access to medical care and cancer screening.