PO.PS01.02 · 人群科学
前列腺癌生存中种族差异的持续存在：一项时变条件生存与死亡率分析
The persistence of racial disparities in prostate cancer survival: A time-varying conditional survival and mortality analysis
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摘要 Abstract
中文摘要
背景：前列腺癌生存中的种族差异已有充分记录，但这些死亡风险如何随着患者生存时间延长而演变尚不清楚。条件生存（CS）通过随时间更新生存估计，为生存者提供了更动态、更准确的预后。
目的：探讨前列腺癌男性患者中癌症特异性生存（CSS）和5年条件生存（CS）的种族差异。我们还评估了按种族划分的经多变量调整的癌症特异性死亡（CSM）风险如何随已生存时间而变化。
方法：我们对来自SEER数据库的235,972名诊断为前列腺癌（2004-2015年）的男性进行了回顾性队列研究，限于已知PSA和Gleason评分的患者。我们采用Kaplan-Meier方法估计诊断时的5年CSS以及已生存1-5年男性的5年CS。拟合了一系列时变多变量Cox比例风险模型以计算CSM的风险比（HR），调整了年龄、社会人口学、肿瘤特征（分期、分级、PSA、Gleason）和治疗。
结果：在诊断时（生存0年），白人男性5年CSS为95.9%，亚裔/太平洋岛民（API）男性为96.2%，黑人男性为94.6%，美洲印第安人/阿拉斯加原住民（AI/AN）男性为92.8%。虽然所有生存满5年的群组的5年CS均有改善，但黑人（95.5%）与白人（96.1%）男性之间的差距虽有缩小但仍持续存在。在诊断时的多变量Cox模型中，黑人男性的CSM风险显著高于白人男性（HR：1.07；95% CI：1.03-1.11，P<0.001）。这种升高的死亡风险并未随时间减弱。相反，API男性具有持续的生存优势（第0年HR：0.72；95% CI：0.68-0.77，P<0.001）。AI/AN男性的死亡风险与白人男性无统计学差异（第0年HR：1.06；95% CI：0.87-1.29，P=0.54）。
结论：前列腺癌生存中的种族差异在诊断时即已确立，对于黑人和API男性，即使在调整了一整套全面的临床和社会人口学因素后，这种差异至少持续5年。黑人男性持续较高的死亡风险凸显了生存差距不仅限于诊断时的因素。AI/AN男性尽管初始CSS较低但无显著差异，值得进一步研究。这些发现对于在长期患者咨询中提供更准确、动态的预后至关重要。
查看英文原文 English abstract
Background: Racial disparities in prostate cancer survival are well-documented, but it is less clear how these mortality risks evolve as patients survive longer. Conditional survival (CS) provides a more dynamic and accurate prognosis for survivors by updating survival estimates over time.
Objective: To investigate racial differences in cancer-specific survival (CSS) and 5-year conditional survival (CS) among men with prostate cancer. We also assessed how the multivariable-adjusted hazard of cancer-specific mortality (CSM) by race changes conditional on time already survived.
Methods: We conducted a retrospective cohort study of 235,972 men diagnosed with prostate cancer (2004-2015) from the SEER database, limited to patients with known PSA and Gleason scores. We used Kaplan-Meier methods to estimate 5-year CSS at diagnosis and 5-year CS for men who had already survived 1-5 years. A series of time-varying multivariable Cox proportional hazards models were fit to calculate Hazard Ratios (HRs) for CSM, adjusting for age, sociodemographics, tumor characteristics (stage, grade, PSA, Gleason), and treatment.
Results: At diagnosis (0 years survived), 5-year CSS was 95.9% for White men, 96.2% for Asian/Pacific Islander (API) men, 94.6% for Black men, and 92.8% for American Indian/Alaska Native (AI/AN) men. While 5-year CS improved for all groups who survived 5 years, the gap between Black (95.5%) and White (96.1%) men narrowed but persisted. In multivariable Cox models at diagnosis, Black men had a significantly higher hazard of CSM compared to White men (HR: 1.07; 95% CI: 1.03-1.11, P < 0.001). This elevated mortality risk did not attenuate over time. Conversely, API men had a persistent survival advantage (HR at Year 0: 0.72; 95% CI: 0.68-0.77, P < 0.001). The mortality hazard for AI/AN men was not statistically different from White men (HR at Year 0: 1.06; 95% CI: 0.87-1.29, P=0.54).
Conclusion: Racial disparities in prostate cancer survival are established at diagnosis and, for Black and API men, persist for at least 5 years, even after adjusting for a comprehensive set of clinical and sociodemographic factors. The persistently higher mortality hazard for Black men highlights that survival gaps are not limited to factors at diagnosis. The lack of a significant difference for AI/AN men, despite lower initial CSS, warrants further investigation. These findings are critical for providing a more accurate, dynamic prognosis in long-term patient counseling.
利益披露 Disclosure
B. Wang, None..
I. Wang, None..
C. Johnstone, None.