Effect of race and socioeconomic status on surgical margins and biochemical outcomes in an equal-access health care setting

Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database

Authors

  • David I. Chu MD,

    1. Division of Urologic Surgery, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina
    2. Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina
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  • Daniel M. Moreira MD,

    1. The Arthur Smith Institute for Urology, North Shore–Long Island Jewish Health System, New Hyde Park, New York
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  • Leah Gerber MSci,

    1. Division of Urologic Surgery, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina
    2. Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina
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  • Joseph C. Presti Jr MD,

    1. Department of Urology, Stanford University Medical Center and Urology Section, Department of Surgery, Veterans Affairs Medical Center, Palo Alto, California
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  • William J. Aronson MD,

    1. Urology Section, Department of Surgery, Veterans Affairs Medical Center, Greater Los Angeles, Los Angeles, California
    2. Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, California
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  • Martha K. Terris MD,

    1. Urology Section, Division of Surgery, Veterans Affairs Medical Centers and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia
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  • Christopher J. Kane MD,

    1. Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, California
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  • Christopher L. Amling MD,

    1. Division of Urology, Department of Surgery, Oregon Health & Science University, Portland, Oregon
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  • Stephen J. Freedland MD

    Corresponding author
    1. Division of Urologic Surgery, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina
    2. Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, North Carolina
    3. Department of Pathology, Duke University School of Medicine, Durham, North Carolina
    • Division of Urology, Box 2626 DUMC, Duke University School of Medicine, Durham, NC 27710

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    • Fax: (919) 668-7093


  • Disclaimer: Views and opinions of, and endorsements by the author(s) do not reflect those of the US Army or the Department of Defense.

Abstract

BACKGROUND:

The impact of race and socioeconomic status (SES) in prostate cancer (CaP) outcomes has been well-studied, but controversy remains. The associations of race/SES with intermediate CaP outcomes, including positive surgical margin (PSM) and biochemical recurrence (BCR), were explored in an equal-access setting.

METHODS:

Data were retrospectively collected from 2502 men in the Shared Equal Access Regional Cancer Hospitals (SEARCH) database who underwent radical prostatectomy from 1989 to 2010. SES (income, education, employment, and poverty) was estimated from linkage of home ZIP code to census data. Logistic regression with adjustment for pre- and postoperative covariates estimated risk for associations between race/SES and pathologic outcomes. Cox proportional hazards models estimated risk for associations between race/SES and time to BCR.

RESULTS:

Black men were more likely to have lower SES than white men (P < .001). On multivariate analysis, race was not associated with PSM, but higher SES was associated with less PSM and fewer Gleason sum ≥ 7 pathologic tumors when SES was assessed by education, employment, or poverty (P trend ≤ .051) and income, employment, or poverty (P trend ≤ 0.059), respectively. Crude Cox models showed black men had higher BCR risk (hazards ratio = 1.20, 95% confidence interval = 1.05-1.38, P = .009) that persisted after adjustment for covariates including SES (hazards ratio ≥ 1.18, P ≤ .040). Higher SES measured by income and poverty were associated with less BCR, but only for black men (P trend ≤ .048).

CONCLUSIONS:

Even in an equal-access setting, higher SES predicted lower PSM risk, and race persisted in predicting BCR despite adjustment for SES. Low SES black patients may be at greatest risk for postprostatectomy BCR. Cancer 2012. © 2012 American Cancer Society.

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