Impact of Asian Race on Prognosis in De Novo Metastatic Prostate Cancer

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Xudong Ni Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Genitourinary Cancer Institute, Shanghai, China

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Michael Luu Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California

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Weiwei Ma Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Genitourinary Cancer Institute, Shanghai, China

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Tingwei Zhang Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Genitourinary Cancer Institute, Shanghai, China

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Yu Wei Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Genitourinary Cancer Institute, Shanghai, China

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Stephen J. Freedland Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California
Durham VA Medical Center, Durham, North Carolina

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Dingwei Ye Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Genitourinary Cancer Institute, Shanghai, China

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Timothy J. Daskivich Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California

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Yao Zhu Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Shanghai Genitourinary Cancer Institute, Shanghai, China

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Background: Little is known about the impact of Asian race on the long-term survival outcomes of males with de novo metastatic prostate cancer (PCa). Understanding racial disparities in survival is critical for accurate prognostic risk stratification and for informing the design of multiregional clinical trials. Methods: This multiple-cohort study included individual patient-level data for males with de novo metastatic PCa from the following 3 cohorts: LATITUDE clinical trial data (n=1,199), the SEER program (n=15,476), and the National Cancer Database (NCDB; n=10,366). Primary outcomes were overall survival (OS) in LATITUDE and NCDB and OS and cancer-specific survival in SEER. Results: Across all 3 cohorts, Asian patients diagnosed with de novo metastatic PCa had better survival than white patients. In LATITUDE, median OS was significantly longer in Asian versus white patients in the androgen deprivation therapy (ADT) + abiraterone + prednisone group (not reached vs 43.8 months; hazard ratio [HR], 0.45; 95% CI, 0.28–0.73; P=.001) as well as in the ADT + placebo group (57.6 vs 32.7 months; HR, 0.51; 95% CI, 0.33–0.78; P=.002). In SEER, among all patients diagnosed with de novo metastatic PCa, median OS was significantly longer in Asian versus white males (49 vs 39 months; HR, 0.76; 95% CI, 0.68–0.84; P<.001). Among those who received chemotherapy, Asian patients again had longer OS (52 vs 42 months; HR, 0.71; 95% CI, 0.52–0.96; P=.025). Using data on cancer-specific survival in SEER resulted in similar conclusions. In NCDB, Asian patients also had longer OS than white patients in aggregate and in subgroups of males treated with ADT or chemotherapy (aggregate: 38 vs 26 months; HR, 0.72; 95% CI, 0.62–0.83; P<.001; ADT subgroup: 41 vs 26 months; HR, 0.71; 95% CI, 0.60–0.84; P<.001; chemotherapy subgroup: 34 vs 25 months; HR, 0.67; 95% CI, 0.57–0.78; P<.001). Conclusions: Asian males have better OS and cancer-specific survival than white males with metastatic PCa across different treatment regimens. This should be considered when assessing prognosis and in designing multinational clinical trials.

Submitted February 19, 2023; final revision received March 30, 2023; accepted for publication March 31, 2023.

Author contributions: Conceptualization: Freedland, Ye, Daskivich, Zhu. Data curation: Daskivich, Zhu. Formal analysis: Ni, Michael. Investigation: All authors. Methodology: Ni, Michael. Writing—original draft: Ni. Writing—review & editing: All authors.

Data availability statement: Data from LATITUDE clinical trials are available to researchers by directly contacting YODA at https://yoda.yale.edu/applications. Deidentified data, including data dictionaries, are available for request per the Yale University Open Data Access (YODA) Project. If the request is approved and if there are no restrictions to YODA sharing data, a data use agreement between the requestor’s institution and Janssen Research & Development, LLC, must be in place before requested data can be released.

Disclosures: Dr. Freedland has disclosed serving as a principal investigator for Pfizer; serving on an advisory board for Pfizer, Astellas, Merck, Janssen, Bayer, Sanofi, AstraZeneca, and Myovant; and serving on the speaker’s bureau for AstraZeneca and Sanofi. The remaining authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This study was supported by Oriental Scholar Professorship, Shanghai Municipal Commission of Education, China (Y. Zhu); National Nature Science Foundation of China (82172621, 81972375; Y. Zhu); Shanghai Medical Innovation Research Special Project (21Y11904300); Shanghai Shenkang Research Physician Innovation and Transformation Ability Training Project (SHDC2022CRD035); General Program of Beijing Xisike Clinical Oncology Research Foundation (Y-MSDZD2021-0230, Y-2019AZMS-0012; Y. Zhu); the Chinese Anti-Cancer Association - Hengrui PARP Inhibitor Cancer Research Foundation; Fudan University (FDUROP No. 22065; X. Ni); and sponsored for the Program of Shanghai Academic/Technology Research Leader (23XC1420600; Y. Zhu).

Disclaimer: The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; or the decision to submit the manuscript for publication.

Correspondence: Yao Zhu, MD, PhD, Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai 200032, China. Email: zhuyao@fudan.edu.cn

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