Racial disparity in survival of African-American (AA) patients diagnosed with metastatic prostate cancer: Analysis of surveillance epidemiology and end results program.

Abstract

28 Background: Amongst all cancers in men, prostate cancer (PCa) is the most common cancer, and the second leading cause of death. Racial disparities in PCa care in the United States (US) are known to exist. However, it is not clear if this disparity is also noted specifically in patients diagnosed with metastatic PCa (metaPCa). We analyzed the Surveillance Epidemiology and End results Program (SEER) 18 registry, to determine the racial disparity in survival of AA patients diagnosed with metaPCa compared to other races recorded in this registry. Methods: Cancer incidence data was obtained from the SEER 18 registry (2000-2018). The data was analyzed using StataMP 16 (StataCorp) software. Demographic and clinical outcomes were recorded from the registry. We performed univariate Cox regression using proportional hazard model and obtained Kaplan Meier curves to look at the difference in survival based on different age groups and race. Results: A total of 51,979 cases were identified with metaPCa, out of whom 75.8% were Whites. 40,579 deaths were recorded. Mean age group of patients with metaPCa were 70-74 years. Grade 3 poorly differentiated adenocarcinoma was noted in 54.6% patients. There was no statistically significant difference in survival of AA patients with metaPCa compared to Non-Hispanic Whites (NHW) (Hazard Ratio (HR): 0.99; 95%CI 0.96,1.03 p = 0.71) or Alaskan and American Natives (AIAN) with metaPCa (HR:1.048; 95%CI 0.91,1.21 p = 0.539). AA with metaPCa had a statistically better outcome compared to Asian and Pacific Islanders with metaPCa (HR:0.775; 95%CI 0.731,0.821 p = 0.00). Amongst patients with less than 65 years of age with metaPCa, AA patients had statistically better survival than NHW (HR: 0.94; 95% CI 0.89-0.98 p = 0.05). No statistically supported racial disparity in survival was observed in patients above 65 years with metaPCa (AA to NHW patients- HR: 0.99; 95% CI 0.96,1.03 p = 0.71). Conclusions: Although racial disparities exist in survival of all patients diagnosed with prostate cancer, when it comes to those with metaPCA, there is no statistically supported racial disparity amongst AA patients compared to NHW, except for those who are younger than 65 years where white patients have a worse outcome compared to AA diagnosed with metaPCa.

The impact of race on survival in metastatic prostate cancer: a systematic literature review

“…Of the 62 records, 47 were full-text publications [ 3 , 20 – 65 ] and 15 were conference abstracts [ 66 – 80 ]. The 54 unique studies consisted of 53 cohort studies [ 3 , 20 – 62 , 64 , 65 , 70 , 71 , 73 , 77 – 80 ] and 1 case control study [ 63 ]. Of these, 50 studies were retrospective [ 3 , 20 – 31 , 33 – 41 , 43 – 63 , 65 , 70 , 71 , 73 , 78 – 80 ], 3 were prospective [ 42 , 64 , 77 ], and 1 was mixed (prospective and retrospective) [ 32 ].…”

“…The 54 unique studies consisted of 53 cohort studies [ 3 , 20 – 62 , 64 , 65 , 70 , 71 , 73 , 77 – 80 ] and 1 case control study [ 63 ]. Of these, 50 studies were retrospective [ 3 , 20 – 31 , 33 – 41 , 43 – 63 , 65 , 70 , 71 , 73 , 78 – 80 ], 3 were prospective [ 42 , 64 , 77 ], and 1 was mixed (prospective and retrospective) [ 32 ]. Research reported in these studies was conducted in the United States (US) ( n = 51) [ 3 , 20 – 27 , 29 – 61 , 63 – 65 , 70 , 71 , 73 , 77 , 78 , 80 ], Europe ( n = 1) [ 62 ], Asia ( n = 1) [ 79 ], and Oceania ( n = 1) [ 28 ].…”

“…Of these, 50 studies were retrospective [ 3 , 20 – 31 , 33 – 41 , 43 – 63 , 65 , 70 , 71 , 73 , 78 – 80 ], 3 were prospective [ 42 , 64 , 77 ], and 1 was mixed (prospective and retrospective) [ 32 ]. Research reported in these studies was conducted in the United States (US) ( n = 51) [ 3 , 20 – 27 , 29 – 61 , 63 – 65 , 70 , 71 , 73 , 77 , 78 , 80 ], Europe ( n = 1) [ 62 ], Asia ( n = 1) [ 79 ], and Oceania ( n = 1) [ 28 ]. The commonly reported racial groups discussed across these studies were Black (i.e., Black, Non-Hispanic Black), White (i.e., White, Non-Hispanic White, Non-Black), Hispanic 1 , Asian (i.e., Asian, Non-Hispanic Asian, Asian/Pacific Islander), and American Indian/Alaska Native (AI/AN) (i.e., AI/AN, Native American).…”

“…The commonly reported racial groups discussed across these studies were Black (i.e., Black, Non-Hispanic Black), White (i.e., White, Non-Hispanic White, Non-Black), Hispanic 1 , Asian (i.e., Asian, Non-Hispanic Asian, Asian/Pacific Islander), and American Indian/Alaska Native (AI/AN) (i.e., AI/AN, Native American). Twenty-seven [ 20 , 22 , 25 , 27 , 30 , 31 , 33 – 36 , 38 , 41 , 48 , 49 , 51 – 58 , 60 , 62 , 70 , 71 , 78 ] of the 54 studies reported results on overall survival (OS) or all-cause mortality, 11 studies [ 21 – 24 , 26 , 31 , 37 , 38 , 44 , 50 , 61 ] reported results on prostate cancer specific mortality (PCSM), and 11 studies [ 29 , 32 , 39 , 46 , 62 – 65 , 73 , 77 , 80 ] reported results on OS or PCSM in patients on specific mPC treatments, with some of the studies reporting on more than one survival outcome. Nine studies [ 3 , 28 , 40 , 42 , 43 , 45 , 47 , 59 , 79 ] reported only descriptive data, described racial groups other than Black, White, Hispanic, Asian, or Native American, such as Maori, Thai, Malaysian, or conducted separate analyses within each racial group.…”

“…Of the 27 studies, 18 reported on mCSPC populations, 6 reported on mCRPC populations, and 3 reported on mixed mCSPC/mCRPC populations. All 27 studies compared OS between Black and White patients, of which 21 (14 mCSPC, 4 mCRPC, 3 mixed) [ 20 , 22 , 25 , 27 , 30 , 31 , 33 – 36 , 38 , 41 , 48 , 51 , 52 , 55 , 57 , 58 , 60 , 62 , 70 ] found no significant difference in OS between the two racial groups. The remaining six studies (4 mCSPC, 2 mCRPC) [ 49 , 53 , 54 , 56 , 71 , 78 ] reported poorer survival in Black patients compared to White patients.…”