Comparison of Response to Definitive Radiotherapy for Localized Prostate Cancer in Black and White Men
Year: 2021
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Importance: Black men have a 2-fold increased risk of dying from prostate cancer compared with White men. However, race-specific differences in response to initial treatment remain unknown. Objective: To compare overall and treatment-specific outcomes of Black and White men with localized prostate cancer receiving definitive radiotherapy (RT). Data Sources: A systematic search was performed of relevant published randomized clinical trials conducted by the NRG Oncology/Radiation Therapy Oncology Group between January 1, 1990, and December 31, 2010. This meta-analysis was performed from July 1, 2019, to July 1, 2021. Study Selection: Randomized clinical trials of definitive RT for patients with localized prostate cancer comprising a substantial number of Black men (self-identified race) enrolled that reported on treatment-specific and overall outcomes. Data Extraction and Synthesis: Individual patient data were obtained from 7 NRG Oncology/Radiation Therapy Oncology Group randomized clinical trials evaluating definitive RT with or without short- or long-term androgen deprivation therapy. Unadjusted Fine-Gray competing risk models, with death as a competing risk, were developed to evaluate the cumulative incidences of end points. Cox proportional hazards models were used to evaluate differences in all-cause mortality and the composite outcome of distant metastasis (DM) or death. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. Main Outcomes and Measures: Subdistribution hazard ratios (sHRs) of biochemical recurrence (BCR), DM, and prostate cancer-specific mortality (PCSM). Results: A total of 8814 patients (1630 [18.5%] Black and 7184 [81.5%] White) were included; mean (SD) age was 69.1 (6.8) years. Median follow-up was 10.6 (IQR, 8.0-17.8) years for surviving patients. At enrollment, Black men were more likely to have high-risk disease features. However, even without adjustment, Black men were less likely to experience BCR (sHR, 0.88; 95% CI, 0.58-0.91), DM (sHR, 0.72; 95% CI, 0.58-0.91), or PCSM (sHR, 0.72; 95% CI, 0.54-0.97). No significant differences in all-cause mortality were identified (HR, 0.99; 95% CI, 0.92-1.07). Upon adjustment, Black race remained significantly associated with improved BCR (adjusted sHR, 0.79; 95% CI, 0.72-0.88; P < .001), DM (adjusted sHR, 0.69; 95% CI, 0.55-0.87; P = .002), and PCSM (adjusted sHR, 0.68; 95% CI, 0.50-0.93; P = .01). Conclusions and Relevance: The findings of this meta-analysis suggest that Black men enrolled in randomized clinical trials present with more aggressive disease but have better BCR, DM, and PCSM with definitive RT compared with White men, suggesting that other determinants of outcome, such as access to care, are important factors of achieving racial equity.
Source: JAMA Network Open
Authors: Ting Martin Ma, Tahmineh Romero, Nicholas G. Nickols, Matthew B. Rettig, Isla P. Garraway, Mack Roach, Jeff M. Michalski, Thomas M. Pisansky, W. Robert Lee, Christopher U. Jones, Seth A. Rosenthal, Chenyang Wang, Holly Hartman, Paul L. Nguyen, Felix Y. Feng, Paul C. Boutros, Christopher Saigal, Karim Chamie, William C. Jackson, Todd M. Morgan, Rohit Mehra, Simpa S. Salami, Randy Vince, Edward M. Schaeffer, Brandon A. Mahal, Robert T. Dess, Michael L. Steinberg, David Elashoff, Howard M. Sandler, Daniel E. Spratt, Amar U. Kishan
Institutions: University of California, Los Angeles, VA Greater Los Angeles Healthcare System, UCLA Health, UCLA Jonsson Comprehensive Cancer Center, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, Washington University in St. Louis, Mayo Clinic, Duke University, Duke Medical Center, Sutter Roseville Medical Center, The University of Texas MD Anderson Cancer Center, University of Michigan, Brigham and Women's Hospital, Harvard University, Dana-Farber Cancer Institute, Dana-Farber Brigham Cancer Center, Northwestern University, Cedars-Sinai Medical Center, University Hospitals Cleveland Medical Center, University Hospitals Seidman Cancer Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W4200518484