Impact of race on survival in men with metastatic hormone-refractory prostate cancer.
OBJECTIVE
To determine whether blacks with hormone-refractory prostate cancer have shorter survival compared with whites with the same disease.


METHODS
Data from eight multicenter trials (four Phase II and four randomized Phase III studies) conducted by the Cancer and Leukemia Group B were combined. Eligible patients had progressive prostate cancer after androgen deprivation therapy (with documented castration levels of testosterone), an Eastern Cooperative Oncology Group performance status of 0 to 2, and adequate hematologic, renal, and hepatic function. The proportional hazards model was used to assess the prognostic importance of race, adjusting for important factors. All statistical tests were two-sided.


RESULTS
Of the 1183 patients, 15% were blacks, 45% of patients had a Gleason sum of 8 or greater, and the median age was 71 years. Of the 1183 patients, 35% had measurable disease and 89% had an Eastern Cooperative Oncology Group performance status of 0 to 1. Blacks were younger, had a shorter interval between diagnosis and study entry, and had greater prostate-specific antigen levels, lower hemoglobin levels, and a lower likelihood of prior prostatectomy than whites. The median survival was 15 months (95% confidence interval 12 to 18) for blacks compared with 14 months (95% confidence interval 13 to 15) for whites. In a multivariate analysis, adjusting for age, performance status, presence of visceral disease, hemoglobin, Gleason sum, prostate-specific antigen level, alkaline phosphatase, lactate dehydrogenase, and years since diagnosis, the hazard ratio was 0.85 (95% confidence interval 0.71 to 1.02, P = 0.08) for blacks compared with whites.


CONCLUSIONS
No statistically significant difference was found in overall survival between blacks and whites with metastatic hormone-refractory prostate cancer.
Halabi
Susan
S
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina 27710, USA.
Small
Eric J
EJ
Vogelzang
Nicholas J
NJ
Barrier
Robert C
RC
George
Stephen L
SL
Gilligan
Timothy D
TD
D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D044383:Black People / Q000235:genetics; D017322:Clinical Trials, Phase II as Topic / Q000706:statistics & numerical data; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D020022:Genetic Predisposition to Disease; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D044469:Racial Groups / Q000235:genetics; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016879:Salvage Therapy; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D044465:White People / Q000235:genetics; D001741:Black or African American
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D006454:Hemoglobins