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Clinical Trial
. 2019 Jul 1;5(7):975-983.
doi: 10.1001/jamaoncol.2019.0826.

Association of Black Race With Prostate Cancer-Specific and Other-Cause Mortality

Robert T Dess  1 , Holly E Hartman  2 , Brandon A Mahal  3 , Payal D Soni  4 , William C Jackson  1 , Matthew R Cooperberg  5 , Christopher L Amling  6 , William J Aronson  7 , Christopher J Kane  8 , Martha K Terris  9 , Zachary S Zumsteg  10 , Santino Butler  3 , Joseph R Osborne  11 , Todd M Morgan  12 , Rohit Mehra  13 , Simpa S Salami  12 , Amar U Kishan  14 , Chenyang Wang  14 , Edward M Schaeffer  15 , Mack Roach 3rd  5   16 , Thomas M Pisansky  17 , William U Shipley  18 , Stephen J Freedland  19   20 , Howard M Sandler  10 , Susan Halabi  21 , Felix Y Feng  5   16 , James J Dignam  22 , Paul L Nguyen  3 , Matthew J Schipper  1   2 , Daniel E Spratt  1
Affiliations
Clinical Trial

Association of Black Race With Prostate Cancer-Specific and Other-Cause Mortality

Robert T Dess et al. JAMA Oncol. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cooperberg reported receiving personal fees from Dendreon during the conduct of the study and personal fees from Astellas, Bayer, MDx Health, and GenomeDx outside the submitted work. Dr Zumsteg reported receiving personal fees from EMD Serono and Scripps Proton Therapy Center outside the submitted work. Dr Kishan reported receiving personal fees from ViewRay, Inc, Varian Medical Systems, Inc, and Janssen Pharmaceuticals outside the submitted work. Dr Schaeffer reported receiving personal fees from GenomeDX, AbbVie, OPKO Health, Inc., and Integra Life Science Services, LLC, outside the submitted work. Dr Sandler reported receiving grants from the American College of Radiology/NRG Oncology during the conduct of the study and personal fees from Janssen Pharmaceuticals and consulting fees from Vivos outside the submitted work. Dr Feng reported receiving personal fees from Janssen Pharmaceuticals, Medivation/Astellas, Sanofi, Dendreon, Bayer, Blue Earth, and Ferring outside the submitted work and being a cofounder of PFS Genomics, a molecular diagnostics company in breast cancer. Dr Nguyen reported receiving personal fees from Dendreon, Ferring, GenomeDX, Nanobiotix, Cota, Blue Earth, and Bayer, grants from Janssen Pharmaceuticals, and personal and consulting fees from Augmenix and Astellas outside the submitted work. Dr Spratt reported receiving personal fees from Janssen Pharmaceuticals and Blue Earth outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative Incidence of Prostate Cancer–Specific Mortality (PCSM) and Other-Cause Mortality (OCM) After Inverse Probability Weighting
Cohorts are derived from the Surveillance, Epidemiology, and End Results database (SEER), a shared equal-access Veterans Affairs regional hospital cohort (VA), and Radiation Therapy Oncology Group randomized clinical trials (RCT).
Figure 2.
Figure 2.. Forest Plot of Fine-Gray Competing-Risk Subdistribution Hazard Ratios (sHRs) of Prostate Cancer–Specific Mortality (PCSM)
Cohorts are derived from the Surveillance, Epidemiology, and End Results database (SEER), a shared equal-access Veterans Affairs regional hospital cohort (VA), and Radiation Therapy Oncology Group randomized clinical trials (RCT).
Figure 3.
Figure 3.. Forest Plot of Fine-Gray Competing-Risk Subdistribution Hazard Ratios (sHRs) of Prostate Cancer–Specific Mortality (PCSM) by National Comprehensive Cancer Network High-Risk Subgroup
Cohorts are derived from the Surveillance, Epidemiology, and End Results database (SEER), a shared equal-access Veterans Affairs regional hospital cohort (VA), and Radiation Therapy Oncology Group randomized clinical trials (RCT).
Figure 4.
Figure 4.. Forest Plot of Fine-Gray Competing-Risk Subdistribution Hazard Ratios (sHRs) of Other-Cause Mortality and HRs of All-Cause Mortality
Cohorts are derived from the Surveillance, Epidemiology, and End Results database (SEER), a shared equal-access Veterans Affairs regional hospital cohort (VA), and Radiation Therapy Oncology Group randomized clinical trials (RCT).
See this image and copyright information in PMC

Comment in

References

    1. DeSantis CE, Siegel RL, Sauer AG, et al. . Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J Clin. 2016;66(4):290-308. doi:10.3322/caac.21340 - DOI - PubMed
    1. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111(10):1233-1241. doi:10.1161/01.CIR.0000158136.76824.04 - DOI - PubMed
    1. Brancati FL, Kao WH, Folsom AR, Watson RL, Szklo M. Incident type 2 diabetes mellitus in African American and white adults: the Atherosclerosis Risk in Communities Study. JAMA. 2000;283(17):2253-2259. doi:10.1001/jama.283.17.2253 - DOI - PubMed
    1. National Cancer Institute NCI Center to Reduce Cancer Health Disparities (CRCHD). https://www.cancer.gov/about-nci/organization/crchd. Published April 5, 2018. Accessed July 6, 2018.
    1. Giordano SH, Kuo YF, Duan Z, Hortobagyi GN, Freeman J, Goodwin JS. Limits of observational data in determining outcomes from cancer therapy. Cancer. 2008;112(11):2456-2466. doi:10.1002/cncr.23452 - DOI - PMC - PubMed

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