Dr. Yao Zhu
Urinary Surgery, Fudan University Shanghai Cancer Center
Dr. Xudong Ni
Fudan University Shanghai Cancer Center
Are there differences in long-term prognosis between Asian and Caucasian patients with new metastatic prostate cancer (mPC)? A study presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO-GU 2023) by Dr. Zhu Yao’s team suggests that among patients receiving different treatment regimens, Asian males have superior overall survival (OS) and cancer-specific survival (CSS) compared to white males in this category. This research highlights the importance of considering Asians as an independent prognostic factor when evaluating individual patient outcomes and the need to include an adequate representation of Asian patients in the design of global multicenter clinical trials.
Background:
Are there differences in long-term survival outcomes between Asian and other racial groups in newly diagnosed metastatic prostate cancer patients? Currently, there is a lack of related research reports. Understanding racial differences in survival is crucial for accurate prognostic risk stratification and the design of global multicenter clinical trials. This study aimed to quantify the differences in long-term cancer-specific survival (CSS) and overall survival (OS) between Asian and white newly diagnosed metastatic prostate cancer patients after controlling for known prognostic variables.
Methods:
This multicohort study included individual data from newly diagnosed metastatic prostate cancer patients from three cohorts. These cohorts included data from the LATITUDE clinical trial (n=1199 [597 patients receiving ADT+abiraterone+prednisone treatment and 602 patients receiving ADT+placebo treatment]), Surveillance, Epidemiology, and End Results (SEER) data (n=15540), and the National Cancer Database (NCDB) data (n=10366). The primary endpoints in LATITUDE and NCDB were OS, while SEER had primary endpoints for both OS and CSS. Survival analysis was conducted using Kaplan-Meier survival curves after propensity score matching (PSM). Hazard ratios were calculated using a multivariate Cox proportional hazards model.
Results:
In all three cohorts, Asian patients diagnosed with newly metastatic prostate cancer had higher survival rates than white patients.
In LATITUDE: Asian males in both the ADT+abiraterone+prednisone group (NR vs. 43.8 months; HR=0.45, 95%CI: 0.28~0.73, P=0.001) and the ADT+placebo group (57.6 vs. 32.7 months; HR=0.51, 95%CI: 0.33~0.78, P=0.002) exhibited significantly longer median OS compared to white males.
In SEER: Among all newly diagnosed metastatic prostate cancer patients, Asian males had significantly longer median OS than white males (49 vs. 39 months; HR=0.76, 95%CI: 0.68~0.84, P<0.001). In patients receiving chemotherapy, Asian males also had longer OS (52 vs. 42 months; HR=0.71, 95%CI: 0.52~0.96, P=0.025). Similar conclusions were drawn using SEER’s CSS data.
In NCDB: Overall, Asian males had significantly longer OS compared to white males (38 vs. 26 months; HR=0.72, 95%CI: 0.62~0.83, P<0.001), and subgroups receiving ADT (41 vs. 26 months; HR=0.71, 95%CI: 0.60~0.84, P<0.001) and chemotherapy (34 vs. 25 months; HR=0.67, 95%CI: 0.57~0.78, P<0.001) also showed longer OS for Asian males compared to white males.
Conclusion:
In newly diagnosed metastatic prostate cancer patients receiving different treatment regimens, Asian males exhibit superior OS and CSS compared to white males. This should be considered in future prognostic evaluations and the design of multinational clinical trials.
