TY - JOUR
T1 - Comparison of Response to Definitive Radiotherapy for Localized Prostate Cancer in Black and White Men
T2 - A Meta-analysis
AU - Ma, Ting Martin
AU - Romero, Tahmineh
AU - Nickols, Nicholas G.
AU - Rettig, Matthew B.
AU - Garraway, Isla P.
AU - Roach, Mack
AU - Michalski, Jeff M.
AU - Pisansky, Thomas M.
AU - Lee, W. Robert
AU - Jones, Christopher U.
AU - Rosenthal, Seth A.
AU - Wang, Chenyang
AU - Hartman, Holly
AU - Nguyen, Paul L.
AU - Feng, Felix Y.
AU - Boutros, Paul C.
AU - Saigal, Christopher
AU - Chamie, Karim
AU - Jackson, William C.
AU - Morgan, Todd M.
AU - Mehra, Rohit
AU - Salami, Simpa S.
AU - Vince, Randy
AU - Schaeffer, Edward M.
AU - Mahal, Brandon A.
AU - Dess, Robert T.
AU - Steinberg, Michael L.
AU - Elashoff, David
AU - Sandler, Howard M.
AU - Spratt, Daniel E.
AU - Kishan, Amar U.
N1 - Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/12/29
Y1 - 2021/12/29
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85122811887&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2021.39769
DO - 10.1001/jamanetworkopen.2021.39769
M3 - Article
C2 - 34964855
AN - SCOPUS:85122811887
SN - 2574-3805
VL - 4
JO - JAMA Network Open
JF - JAMA Network Open
IS - 12
M1 - LBA5009
ER -