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. 2022 Nov 21;21(3):135-141.
doi: 10.1080/2090598X.2022.2148867. eCollection 2023.

Racial/ethnic disparities in the distribution and effect of type and number of high-risk criteria on mortality in prostate cancer patients treated with radiotherapy

Francesco Chierigo  1   2   3 , Rocco Simone Flammia  2   4 , Gabriele Sorce  2   5 , Benedikt Hoeh  2   6 , Lukas Hohenhorst  2   7 , Andrea Panunzio  2   8 , Zhe Tian  2 , Fred Saad  2 , Markus Graefen  7 , Michele Gallucci  4 , Alberto Briganti  5 , Francesco Montorsi  5 , Felix K H Chun  6 , Shahrokh F Shariat  9   10   11   12   13   14 , Alessandro Antonelli  8 , Giovanni Guano  1   3 , Guglielmo Mantica  1   3 , Marco Borghesi  1   3 , Nazareno Suardi  1   3 , Carlo Terrone  1   3 , Pierre I Karakiewicz  2
Affiliations

Racial/ethnic disparities in the distribution and effect of type and number of high-risk criteria on mortality in prostate cancer patients treated with radiotherapy

Francesco Chierigo et al. Arab J Urol. .

Abstract

Objective: To assess differences in the distribution of type and number of D'Amico high-risk criteria (DHRCs) according to race/ethnicity (R/E) and their effect on cancer-specific mortality (CSM) in prostate cancer (PCa) patients treated with external beam radiotherapy (RT).

Methods: In the SEER database (2004-2016), we identified 31,002 PCa patients treated with RT with at least one DHRCs, namely PSA >20 ng/dL, biopsy Gleason Grade Group 4-5, and clinical T stage ≥T2c. Competing risks regression (CRR) model tested the association between DHRCs and 5-year CSM in all R/E subgroups.

Results: Of 31,002 patients, 20,894 (67%) were Caucasian, 5256 (17%) were African American, 2868 (9.3%) were Hispanic-Latino, and 1984 (6.4%) were Asian. The distributions of individual DHRCs and combinations of two DHRCs differed according to R/E, but not for the combination of three DHRCs. The effect related to the presence of a single DHRC, and combinations of two or three DHRCs on absolute CSM rates was lowest in Asians (1.2-6.8%), followed by in African Americans (2.3-12.2%) and Caucasians (2.3-12.1%), and highest in Hispanic/Latinos (1.7-13.8%). However, the opposite effect was observed in CRR, where hazard ratios were highest in Asians vs. other R/Es: Asians 1.00-2.59 vs. others 0.5-1.83 for one DHRC, Asians 3.4-4.75 vs. others 0.66-3.66 for two DHRCs, and Asians 7.22 vs. others 3.03-4.99 for all three DHRCs.

Conclusions: R/E affects the proportions of DHRCs. Moreover, within the four examined R/E groups, the effect of DHRCs on absolute and relative CSM metrics also differed. Therefore, R/E-specific considerations may be warranted in high-risk PCa patients treated with RT.

Keywords: CSM; D’Amico high-risk criteria; SEER; race/ethnicity; radiotherapy.

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Conflict of interest statement

The research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1.
Figure 1.
Forest plots depicting hazard ratios, their respective 95% confidence intervals, and p-values of the competing risks regression models testing the association between cancer-specific mortality (CSM), after adjustment for other cause mortality (OCM), and type and number of high-risk criteria in D’Amico high-risk prostate cancer (PCa) patients treated with external beam radiotherapy. All analyses were stratified according to race/ethnicity.
See this image and copyright information in PMC

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