Race and Prostate Cancer: What Do We Know?

C. D. Young, M. Roach
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引用次数: 4

Abstract

Objectives: Is race an independent prognostic indicator of outcome and overall survival in prostate cancer? African American men have been reported to have the highest incidence and mortality rates for prostate cancer worldwide, but the evidence to explain this is confusing at best. Materials and Methods: A literature search was conducted, and an effort was made to include all articles published in the last 15 years that evaluated the independent significance of race on survival or disease-free survival from prostate cancer. Special attention was given to the major prospective randomized trials in which the initial workups, evaluations, and treatments were relatively uniform and in which the opportunity for confounding variables were small. Results: The appearance of a difference in outcome due to race is most likely a result of an epidemiologic phenomenon that arises when evaluating two different populations that have different distributions with regard to severity of disease. African Americans tend to present with higher prostate specific antigen (PSA) levels and higher Gleason scores, and a larger percentage are likely to belong to the groups with the higher risk of failure, creating the impression that failure is due to race. Conclusions: On examination of the prospective randomized trials in the literature, “race-based” explanations for differences in survival should be viewed with a moderate degree of skepticism. So-called “epigenetic” factors may explain the higher incidence of prostate cancer noted in numerous studies.
种族和前列腺癌:我们知道什么?
目的:种族是前列腺癌预后和总生存期的独立预后指标吗?据报道,非裔美国男性的前列腺癌发病率和死亡率在世界范围内是最高的,但解释这一点的证据充其量是令人困惑的。材料和方法:进行文献检索,并努力纳入过去15年内发表的所有评估种族对前列腺癌生存或无病生存的独立意义的文章。特别注意的是主要的前瞻性随机试验,在这些试验中,最初的检查、评估和治疗相对统一,混杂变量的机会很小。结果:由于种族导致的结果差异的出现很可能是在评估具有不同疾病严重程度分布的两个不同人群时产生的流行病学现象的结果。非裔美国人往往具有较高的前列腺特异性抗原(PSA)水平和较高的Gleason评分,并且更大比例的非裔美国人可能属于失败风险较高的群体,给人一种失败是由种族造成的印象。结论:通过对文献中前瞻性随机试验的检查,对生存差异的“基于种族”的解释应该持中等程度的怀疑态度。在许多研究中,所谓的“表观遗传”因素可以解释前列腺癌的高发病率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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