Racial disparities in lymph node dissection at radical prostatectomy: A Surveillance, Epidemiology and End Results database analysis.

Overview

abstract

OBJECTIVES: To test for racial disparities in lymph node dissection rates, lymph node dissection extent, lymph node invasion rates and cancer-specific mortality in North American African Americans versus non-Hispanic whites, at radical prostatectomy for clinically localized prostate cancer. METHODS: Within the Surveillance, Epidemiology and End Results database (2010-2014), we identified 58 974 African Americans or non-Hispanic whites with prostate cancer, who underwent radical prostatectomy with available clinical stage, prostate-specific antigen and biopsy Gleason score. Annual trends were examined. Logistic regression models focused on lymph node dissection rates, lymph node dissection extent (number of removed lymph nodes) and lymph node invasion. Cox regression models tested for differences in cancer-specific mortality. Multivariable models were adjusted for D'Amico risk groups, age and year. Models predicting lymph node invasion and cancer-specific mortality were additionally adjusted for lymph node dissection extent. RESULTS: Among all patients, 14.5% were African Americans. Lymph node dissection was carried out in 60.0% of African Americans versus 59.5% of non-Hispanic whites (P = 0.4). The median number of removed lymph nodes was five in African Americans versus six in non-Hispanic whites (P < 0.001). Furthermore, 3.1% versus 3.3% of African Americans and non-Hispanic whites, respectively, harbored lymph node invasion (P = 0.3). In multivariable logistic regression models African American race did not affect lymph node dissection or lymph node invasion rates, but lymph node dissection extent was lower in African Americans (hazard ratio 0.9; P < 0.001). No statistical differences in cancer-specific mortality were identified according to race. CONCLUSIONS: Contemporary North American African American patients treated with radical prostatectomy have equal access to lymph node dissection, the same lymph node invasion rates and the same cancer-specific mortality rates as non-Hispanic whites. However, the extent of lymph node dissection is lower in African Americans. The results regarding lymph node dissection rates are encouraging. However, improvements are required regarding lymph node dissection extent in African Americans.