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).
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.
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.
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.
Arab journal of urology. 2022 Nov 21*** epublish ***
Francesco Chierigo, Rocco Simone Flammia, Gabriele Sorce, Benedikt Hoeh, Lukas Hohenhorst, Andrea Panunzio, Zhe Tian, Fred Saad, Markus Graefen, Michele Gallucci, Alberto Briganti, Francesco Montorsi, Felix K H Chun, Shahrokh F Shariat, Alessandro Antonelli, Giovanni Guano, Guglielmo Mantica, Marco Borghesi, Nazareno Suardi, Carlo Terrone, Pierre I Karakiewicz
Department of Urology, , IRCCS Ospedale Policlinico San MartinoGenova, Italy., Cancer Prognostics and Health Outcomes Unit, Division of Urology, , University of Montréal Health CenterMontréal, Québec, Canada., Martini-Klinik Prostate Cancer Center, , University Hospital Hamburg-EppendorfHamburg, Germany., Department of Maternal-Child and Urological Sciences, , Sapienza Rome University, Policlinico Umberto I HospitalRome, Italy., Division of Experimental Oncology/Unit of Urology, , URI, Urological Research Institute, IRCCS San Raffaele Scientific InstituteMilan, Italy., Department of Urology, , University Hospital FrankfurtFrankfurt am Main, Germany., Department of Urology, , Comprehensive Cancer Center, Medical University of ViennaVienna, Austria., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona.