Effect of chemotherapy in metastatic prostate cancer according to race/ethnicity groups

• Published in: The Prostate Vol. 82; no. 6; pp. 676 - 686
• Main Authors: Hoeh, Benedikt, Würnschimmel, Christoph, Flammia, Rocco Simone, Horlemann, Benedikt, Sorce, Gabriele, Chierigo, Francesco, Tian, Zhe, Saad, Fred, Graefen, Markus, Gallucci, Michele, Briganti, Alberto, Terrone, Carlo, Shariat, Shahrokh F., Tilki, Derya, Kluth, Luis A., Mandel, Philipp, Chun, Felix K. H., Karakiewicz, Pierre I.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2022
• Subjects: African Americans; Asian people; Chemotherapy; Epidemiology; Ethnicity; Hispanic Americans; Humans; Male; Metastases; Metastasis; metastatic prostate cancer; Minority & ethnic groups; Prostate cancer; Prostatic Neoplasms - pathology; race/ethnicity disparities; Regression analysis; Survival; Survival Rate; White people; Whites; chemotherapy; race/ethnicity disparities; metastatic prostate cancer
• ISSN: 0270-4137; 1097-0045; 1097-0045
• DOI: 10.1002/pros.24312

Background No North‐American study tested the survival benefit of chemotherapy in de novo metastatic prostate cancer according to race/ethnicity. We addressed this void. Methods We identified de novo metastatic prostate cancer patients within the Surveillance, Epidemiology, and End Results database (2014–2015). Separate and specific Kaplan–Meier plots and Cox regression models tested for overall survival differences between chemotherapy‐exposed versus chemotherapy‐naïve patients in four race/ethnicity groups: Caucasian versus African‐American versus Hispanic/Latino vs Asian. Race/ethnicity specific propensity score matching was applied. Here, additional landmark analysis was performed. Results Of 4232 de novo metastatic prostate cancer patients, 2690 (63.3%) were Caucasian versus 783 (18.5%) African‐American versus 504 (11.8%) Hispanic/Latino versus 257 (6.1%) Asian. Chemotherapy rates were: 21.3% versus 20.8% versus 21.0% versus 20.2% for Caucasians versus African‐Americans versus Hispanic/Latinos versus Asians, respectively. At 30 months of follow‐up, overall survival rates between chemotherapy‐exposed versus chemotherapy‐naïve patients were 61.5 versus 53.2% (multivariable hazard ratio [mHR]: 0.76, 95 confidence interval [CI]: 0.63–0.92, p = 0.004) in Caucasians, 55.2 versus 51.6% (mHR: 0.76, 95 CI: 0.54–1.07, p = 0.11) in African‐Americans, 62.8 versus 57.0% (mHR: 1.11, 95 CI: 0.73–1.71, p = 0.61) in Hispanic/Latinos and 77.7 versus 65.0% (mHR: 0.31, 95 CI: 0.11–0.89, p = 0.03) in Asians. Virtually the same findings were recorded after propensity score matching within each race/ethnicity group. Conclusions Caucasian and Asian de novo metastatic prostate cancer patients exhibit the greatest overall survival benefit from chemotherapy exposure. Conversely, no overall survival benefit from chemotherapy exposure could be identified in either African‐Americans or Hispanic/Latinos. Further studies are clearly needed to address these race/ethnicity specific disparities.