Socioeconomic status, race, and long-term outcomes after radical prostatectomy in an equal access health system: Results from the SEARCH database
Socioeconomic status, race, and long-term outcomes after radical prostatectomy in an equal access health system: Results from the SEARCH database
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DOI：
10.1016/j.urolonc.2018.12.004
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发表时间：
2019-04-01
影响因子：
2.7
通讯作者：
Freedland, Stephen J.
中科院分区：
文献类型：
--
作者：
Everist, Mary M.;Howard, Lauren E.;Freedland, Stephen J.
简介：我们之前发现根治性前列腺切除术 (RP) 后生化复发 (BCR) 的种族差异在调整社会经济地位 (SES) 后仍然存在，而 SES 不能预测 BCR。对前列腺癌（PC）长期结果的影响尚不清楚。我们假设，无论种族如何，较高的 SES 都会带来更好的长期结果。 方法：在 SEARCH 数据库中，从 1988 年到 2015 年，在 4,787 名接受 RP 的黑人和白人中，贫困（主要 SES 指标）是通过将家庭邮政编码与人口普查数据联系起来来估计的。 Cox 模型用于测试根据人口统计学、临床病理学特征和种族进行调整后的 SES 与 BCR、去势抵抗性 PC (CRPC)、转移、PC 特异性死亡率 (PCSM) 和全因死亡率之间的关联。测试了种族和 SES 之间的相互作用。结果：中位随访时间为 98 个月（四分位数范围：54-150 个月）。 BCR 的种族和 SES 之间没有相互作用。黑人男性的 BCR 风险增加 10% 至 11%（P < 0.06），而 SES 与 BCR 无关。 SES 与 CRPC (P = 0.002)、转移 (P = 0.014) 和 PCSM (P = 0.004) 的种族之间存在交互作用。在黑人中，较低的 SES 与 CRPC (P = 0.012)、转移 (P = 0.004) 和 PCSM (P = 0.049) 减少相关，但与白人无关（所有 P = 0.22）。较高的 SES 与两个种族的全因死亡率降低相关。结论：在平等机会环境中，较低的 SES 与黑人而非白人的 CRPC、转移和 PCSM 降低相关。如果得到证实，这些发现表明种族、SES 和 PC 之间存在复杂的关系，需要进一步研究来了解为什么黑人男性的低 SES 会降低 RP 后 PC 不良结果的风险。由爱思唯尔公司出版
Introduction: We previously found racial differences in biochemical recurrence (BCR) after radical prostatectomy (RP) persisted after adjusting for socioeconomic status (SES) while SES did not predict BCR. The impact on long-term prostate cancer (PC) outcomes is unclear. We hypothesized higher SES would associate with better long-term outcomes regardless of race.Methods: Among 4,787 black and white men undergoing RP from 1988 to 2015 in the SEARCH Database, poverty (primary SES measure) was estimated by linking home ZIP-code to census data. Cox models were used to test the association between SES adjusting for demographic, clinicopathological features, and race with BCR, castration-resistant PC (CRPC), metastases, PC-specific mortality (PCSM), and all-cause mortality. Interactions between race and SES were tested.Results: Median follow-up was 98 months (Interquartile range: 54-150 months). There were no interactions between race and SES for BCR. Black men had 10%-to 11% increased BCR risk (P < 0.06) while SES was unrelated to BCR. There were interactions between SES and race for CRPC (P = 0.002), metastasis (P = 0.014), and PCSM (P = 0.004). Lower SES was associated with decreased CRPC (P = 0.012), metastases (P = 0.004), and PCSM (P = 0.049) in black, but not white men (all P = 0.22). Higher SES was associated with decreased all-cause mortality in both races.Conclusions: In an equal-access setting, lower SES associated with decreased CRPC, metastases, and PCSM in black but not white men. If confirmed, these findings suggest a complex relationship between race, SES, and PC with further research needed to understand why low SES in black men decreased the risk for poor PC outcomes after RP. Published by Elsevier Inc.