Association of Black Race With Prostate Cancer-Specific and Other-Cause Mortality
Association of Black Race With Prostate Cancer-Specific and Other-Cause Mortality
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DOI：
10.1001/jamaoncol.2019.0826
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发表时间：
2019-07-01
期刊：
影响因子：
28.4
通讯作者：
Spratt, Daniel E.
中科院分区：
文献类型：
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作者：
Dess, Robert T.;Hartman, Holly E.;Spratt, Daniel E.
黑人男性比白色男性更容易死于前列腺癌。在具有相似疾病阶段的男性中，生物学与非生物学差异对这种观察到的差异的贡献尚不清楚。目的在控制已知的预后变量和前列腺癌男性患者的护理后，量化黑人种族与长期生存结局的相关性。这项多队列研究包括来自以下3个队列的临床T1- 4 N 0 - 1 M0前列腺癌男性的更新个体患者水平数据：监测、流行病学和最终结果（SEER [n = 296 273]）;退伍军人事务部卫生系统内的5个平等访问区域医疗中心（VA [n = 3972]）;以及4项由国家癌症研究所申办的放射治疗肿瘤学组3期随机临床试验（RCT [n = 5854]）。从1992年1月1日至2013年12月31日收集了3个队列的数据，并从2017年4月27日至2019年4月13日进行了分析。在VA和RCT队列中，所有患者分别接受了手术和放疗，目的是治愈。在SEER中，接受根治性治疗、激素治疗或保守治疗。主要结局和指标前列腺癌特异性死亡率（PCSM）。次要指标包括其他原因死亡率（OCM）。为了调整人口统计学、癌症和治疗相关的基线差异，进行了逆概率加权（IPW）。（平均[SD]年龄，64.9 [8.9]岁），黑人男性构成52840例患者（17.8%），VA队列1513例（38.1%），RCT队列1129例（19.3%）。在SEER队列中，黑人与年龄调整后PCSM风险增加相关（子分布风险比[sHR]，1.30; 95%CI，1.23-1.37; P <0.001）。调整IPW后，黑人与诊断后10年PCSM增加0.5%（95%CI，0.2%-0.9%）相关（sHR，1.09; 95%CI，1.04-1.15; P <0.001），高危男性无显著差异（sHR，1.04; 95%CI，0.97-1.12; P = 0.29）。在VA IPW队列中未发现PCSM的显著差异（sHR，0.85; 95%CI，0.56-1.30; P = 0.46），在RCT IPW队列中黑人男性的风险显著较低（sHR，0.81; 95%CI，0.66-0.99; P = 0.04）。在SEER中，黑人男性的OCM风险显著增加（sHR，1.30; 95% CI，1.27-1.34; P < .001）和RCT（sHR，1.17; 95% CI，1.06-1.29;结论和相关性在这项研究中，在调整了非生物学差异后，特别是获得护理和标准化治疗的机会，黑人种族似乎与较差的逐阶段PCSM无关。黑人男性非转移性前列腺癌的OCM仍存在很大的差异。
IMPORTANCE Black men are more likely to die of prostate cancer than white men. In men with similar stages of disease, the contribution of biological vs nonbiological differences to this observed disparity is unclear.OBJECTIVE To quantify the association of black race with long-term survival outcomes after controlling for known prognostic variables and access to care among men with prostate cancer.DESIGN, SETTING, AND PARTICIPANTS This multiple-cohort study included updated individual patient-level data of men with clinical T1-4N0-1M0 prostate cancer from the following 3 cohorts: Surveillance, Epidemiology, and End Results (SEER [n = 296 273]); 5 equal-access regional medical centers within the Veterans Affairs health system (VA [n = 3972]); and 4 pooled National Cancer Institute-sponsored Radiation Therapy Oncology Group phase 3 randomized clinical trials (RCTs [n = 5854]). Data were collected in the 3 cohorts from January 1, 1992, through December 31, 2013, and analyzed from April 27, 2017, through April 13, 2019.EXPOSURES In the VA and RCT cohorts, all patients received surgery and radiotherapy, respectively, with curative intent. In SEER, radical treatment, hormone therapy, or conservative management were received.MAIN OUTCOMES AND MEASURES Prostate cancer-specific mortality (PCSM). Secondary measures included other-cause mortality (OCM). To adjust for demographic-, cancer-, and treatment-related baseline differences, inverse probability weighting (IPW) was performed.RESULTS Among the 306 100 participants included in the analysis (mean [SD] age, 64.9 [8.9] years), black men constituted 52 840 patients (17.8%) in the SEER cohort, 1513 (38.1%) in the VA cohort, and 1129 (19.3%) in the RCT cohort. Black race was associated with an increased age-adjusted PCSM hazard (subdistribution hazard ratio [sHR], 1.30; 95% CI, 1.23-1.37; P < .001) within the SEER cohort. After IPW adjustment, black race was associated with a 0.5%(95% CI, 0.2%-0.9%) increase in PCSM at 10 years after diagnosis (sHR, 1.09; 95% CI, 1.04-1.15; P < .001), with no significant difference for high-risk men (sHR, 1.04; 95% CI, 0.97-1.12; P = .29). No significant differences in PCSM were found in the VA IPW cohort (sHR, 0.85; 95% CI, 0.56-1.30; P = .46), and black men had a significantly lower hazard in the RCT IPW cohort (sHR, 0.81; 95% CI, 0.66-0.99; P = .04). Black men had a significantly increased hazard of OCM in the SEER (sHR, 1.30; 95% CI, 1.27-1.34; P < .001) and RCT (sHR, 1.17; 95% CI, 1.06-1.29; P = .002) IPW cohorts.CONCLUSIONS AND RELEVANCE In this study, after adjustment for nonbiological differences, notably access to care and standardized treatment, black race did not appear to be associated with inferior stage-for-stage PCSM. A large disparity remained in OCM for black men with nonmetastatic prostate cancer.