Racial differences in initial treatment for clinically localized prostate cancer - Results from the prostate cancer outcomes study
Racial differences in initial treatment for clinically localized prostate cancer - Results from the prostate cancer outcomes study
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DOI：
10.1046/j.1525-1497.2003.21105.x
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发表时间：
2003-10-01
影响因子：
5.7
通讯作者：
Potosky, AL
中科院分区：
文献类型：
--
作者：
Hoffman, RM;Harlan, LC;Potosky, AL
目的：我们研究了临床局限性前列腺癌的初始治疗是否存在种族差异，并调查了人口统计学、社会经济学、临床或肿瘤特征是否可以解释任何种族差异。设计：前瞻性队列研究。设置：康涅狄格州、洛杉矶和亚特兰大的基于人群的肿瘤登记。参与者：我们评估了1144名非裔美国人和非西班牙裔白色男性，年龄在50 - 74岁之间，在1994年10月至1995年10月之间诊断为临床局限性癌症。测量和主要结果：我们从患者调查和病历摘要中获得了人口统计学、社会经济学和临床数据。我们报告了根据多项式逻辑回归得出的接受治疗的调整百分比。我们发现了种族和肿瘤侵袭性之间的相互作用。在患有更具侵袭性癌症（PSA大于或等于20 ng/mL或Gleason评分大于或等于8）的男性中，非裔美国人比非西班牙裔白人更不可能接受根治性直肠癌切除术（35.2% vs 52.0%），但更可能接受保守治疗（38.9% vs 16.3%，P= 0.003）。在71%侵袭性较低的癌症患者中，非裔美国人和非西班牙裔白人接受根治性直肠癌切除术或放射治疗的可能性相同（80.0% vs 84.5%，P= .2）。结论：侵袭性较强的癌症患者接受根治性直肠癌切除术的可能性较低，更可能接受保守治疗。这些治疗差异可能反映了非裔美国人更有可能出现病理晚期癌症，而手术效果有限。在大多数患有侵袭性较低癌症的男性中，接受根治性前列腺切除术或放射治疗没有种族差异。
OBJECTIVE: We examined whether there were racial differences in initial treatment for clinically localized prostate cancer and investigated whether demographic, socioeconomic, clinical, or tumor characteristics could explain any racial differences.DESIGN: Prospective cohort study.SETTING: Population-based tumor registries in Connecticut, Los Angeles, and Atlanta.PARTICIPANTS: We evaluated 1144 African-American and non-Hispanic white men, aged 50 to 74 years, with clinically localized cancer diagnosed between October 1994 and October 1995.MEASUREMENTS AND MAIN RESULTS: We obtained demographic, socioeconomic, and clinical data from patient surveys and medical record abstractions. We reported adjusted percentages for receiving treatment derived from multinomial logistic regression. We found an interaction between race and tumor aggressiveness. Among men with more aggressive cancers (PSA greater than or equal to 20 ng/mL or Gleason score greater than or equal to 8), African Americans were less likely to undergo radical prostatectomy than non-Hispanic whites (35.2% vs 52.0%), but more likely to receive conservative management (38.9% vs 16.3%, P= .003). Among the 71% of subjects with less aggressive cancers, African Americans and non-Hispanic whites were equally likely to receive either radical prostatectomy or radiation therapy (80.0% vs 84.5%, P= .2).CONCLUSIONS: African Americans with more aggressive cancers were less likely to undergo radical prostatectomy and more likely to be treated conservatively. These treatment differences may reflect African Americans' greater likelihood for presenting with pathologically advanced cancer for which surgery has limited effectiveness. Among men with less aggressive cancers-the majority of cases-there were no racial differences in undergoing radical prostatectomy or radiation therapy.