研究比較不同族裔低風險前列腺癌患者主動監測對臨床預後的影響
作者：
小柯機器人發布時間：2020/11/5 14:31:31
美國VHA聖地牙哥醫療保健系統Brent S. Rose團隊比較了非裔美國男性與非西班牙裔白人男性低風險前列腺癌患者主動監測對臨床預後的影響。2020年11月3日，該研究發表在《美國醫學會雜誌》上。
患有低風險前列腺癌的非裔美國男性可能比非西班牙裔白人男性更容易病情加重。因此，尚不清楚主動監測對非裔美國男性是否安全。
為了比較低風險前列腺癌的非裔美國人和非西班牙裔白人男性主動監測管理的臨床預後，研究組在美國退伍軍人衛生管理局醫療體系中進行了一項回顧性隊列研究，招募2001年1月1日至2015年12月31日期間被診斷為低危前列腺癌的美國非裔黑人和非西班牙裔白人男性，並進行主動監測。最終隨訪日期為2020年3月31日。主要結局為至少進展至中等風險、確定性治療、轉移、前列腺癌特異性死亡率和全因死亡率。
研究隊列包括8726名男性，其中2280名為非裔美國人男性（26.1％），中位年齡為63.2歲；6446名為非西班牙裔白人男性（73.9％），中位年齡為65.5歲，均中位隨訪7.6年。
在非裔美國人男性和非西班牙裔白人男性中，疾病進展的10年累積發生率分別為59.9％和48.3％，差異顯著；接受最終治療的比例分別為54.8％和41.4％，差異顯著。兩組間前列腺癌的轉移率分別為1.5％和1.4％，前列腺癌特異性死亡率分別為1.1％和1.0％，全因死亡率分別為22.4％和23.5％，差異均不顯著。
總之，在這項針對低危前列腺癌男性的長期隨訪回顧性隊列研究中，與非西班牙裔白人男性相比，非裔美國人男性10年累積疾病進展和接受明確治療的發生率顯著升高，但未增加癌症轉移或前列腺癌特異性死亡的風險。
附：英文原文
Title: Association Between African American Race and Clinical Outcomes in Men Treated for Low-Risk Prostate Cancer With Active Surveillance
Author: Rishi Deka, P. Travis Courtney, J. Kellogg Parsons, Tyler J. Nelson, Vinit Nalawade, Elaine Luterstein, Daniel R. Cherry, Daniel R. Simpson, Arno J. Mundt, James D. Murphy, Anthony V. D』Amico, Christopher J. Kane, Maria Elena Martinez, Brent S. Rose
Issue&Volume: 2020/11/03
Abstract:
Importance There is concern that African American men with low-risk prostate cancer may harbor more aggressive disease than non-Hispanic White men. Therefore, it is unclear whether active surveillance is a safe option for African American men.
Objective To compare clinical outcomes of African American and non-Hispanic White men with low-risk prostate cancer managed with active surveillance.
Design, Setting, and Participants Retrospective cohort study in the US Veterans Health Administration Health Care System of African American and non-Hispanic White men diagnosed with low-risk prostate cancer between January 1, 2001, and December 31, 2015, and managed with active surveillance. The date of final follow-up was March 31, 2020.
Exposures Active surveillance was defined as no definitive treatment within the first year of diagnosis and at least 1 additional surveillance biopsy.
Main Outcomes and Measures Progression to at least intermediate-risk, definitive treatment, metastasis, prostate cancer–specific mortality, and all-cause mortality.
Results The cohort included 8726 men, including 2280 African American men (26.1%) (median age, 63.2 years) and 6446 non-Hispanic White men (73.9%) (median age, 65.5 years), and the median follow-up was 7.6 years (interquartile range, 5.7-9.9; range, 0.2-19.2). Among African American men and non-Hispanic White men, respectively, the 10-year cumulative incidence of disease progression was 59.9% vs 48.3% (difference, 11.6% [95% CI, 9.2% to 13.9%); P<.001); of receipt of definitive treatment, 54.8% vs 41.4% (difference, 13.4% [95% CI, 11.0% to 15.7%]; P<.001); of metastasis, 1.5% vs 1.4% (difference, 0.1% [95% CI, –0.4% to 0.6%]; P=.49); of prostate cancer–specific mortality, 1.1% vs 1.0% (difference, 0.1% [95% CI, –0.4% to 0.6%]; P=.82); and of all-cause mortality, 22.4% vs 23.5% (difference, 1.1% [95% CI, –0.9% to 3.1%]; P=0.09).
Conclusions and Relevance In this retrospective cohort study of men with low-risk prostate cancer followed up for a median of 7.6 years, African American men, compared with non-Hispanic White men, had a statistically significant increased 10-year cumulative incidence of disease progression and definitive treatment, but not metastasis or prostate cancer–specific mortality. Longer-term follow-up is needed to better assess the mortality risk.
DOI: 10.1001/jama.2020.17020
Source: https://jamanetwork.com/journals/jama/article-abstract/2772493