Outcomes of Black men with prostate cancer treated with radiation therapy in the Veterans Health Administration
| Autor: | Tyler F. Stewart, Abhishek Kumar, Arno J. Mundt, Reith R Sarkar, Isla P. Garraway, John P. Einck, Julia A. Lynch, Brent S. Rose, Kosj Yamoah, Rana R. McKay, James D. Murphy |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty medicine.medical_treatment Population Veterans Health 03 medical and health sciences Prostate cancer 0302 clinical medicine Internal medicine medicine Clinical endpoint Humans Cumulative incidence 030212 general & internal medicine education Aged Proportional Hazards Models Aged 80 and over education.field_of_study Proportional hazards model business.industry Hazard ratio Prostatic Neoplasms Middle Aged Prostate-Specific Antigen medicine.disease Black or African American Radiation therapy Oncology 030220 oncology & carcinogenesis Cohort business |
| Zdroj: | Cancer. 127:403-411 |
| ISSN: | 1097-0142 0008-543X |
| DOI: | 10.1002/cncr.33224 |
| Popis: | BACKGROUND Population-based studies demonstrate that Black men in the United States have an increased risk of death from prostate cancer. Determinants of racial disparities are multifactorial, including socioeconomic and biologic factors. METHODS The authors conducted a pooled analysis of patients derived from 152 centers within the Veterans Health Administration. The cohort included men who had nonmetastatic prostate diagnosed between 2001 and 2015 and received definitive radiation therapy. The primary endpoint was prostate cancer-specific mortality (PCSM). Secondary endpoints included all-cause mortality (ACM) and the time from a prostate-specific antigen level ≥4 ng/mL to biopsy and radiation therapy. A Cox regression model was performed to adjust for differences between clinical parameters. RESULTS Among the 31,131 patients included in the cohort, 9584 (30.8%) were Black. The 10-year cumulative incidence of death from prostate cancer was lower in Black men compared with White men (4.0% vs 4.8%; P = .004). In a competing risk model, Black race was associated with a decreased risk of PCSM (subdistribution hazard ratio, 0.79; 95% CI, 0.69-0.92; P = .002). Similarly, the 10-year cumulative incidence of death from any cause was lower in Black men (27.6% vs 31.8%; P < .001). In multivariable analysis, Black men had a 10% decreased risk of ACM (hazard ratio, 0.90; 95% CI, 0.85-0.95; P < .001). CONCLUSIONS The current results indicate relatively lower PCSM and ACM among Black men who were included in a large Veterans Health Administration cohort and received radiation therapy as primary treatment for nonmetastatic prostate cancer. There is an ongoing need to continue to understand and mitigate the factors associated with disparities in health care outcomes. |
| Databáze: | OpenAIRE |
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