Assistant Professor Weill Cornell Medicine, United States
Background: Robot-assisted radical prostatectomy (RARP) was a new medical technology introduced into the treatment of prostate cancer in the 2000s. Current evidence is insufficient to decompose the association between RARP and racial and ethnic disparities in post-prostatectomy outcomes.
Objectives: To determine whether the differences in short-term surgical and health outcomes between patients undergoing RARP and those treated with open radical prostatectomy (ORP) differ by racial and ethnic groups.
Methods: This retrospective cohort study used New York State Cancer Registry data linked to state discharge records. We identified adult patients who were diagnosed with localized prostate cancer between 2007 and 2017 and underwent radical prostatectomy between October 2008 and December 2018. The exposure variables were race/ethnicity (non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic) and surgical approach (RARP and ORP). Primary outcomes were postoperative major events (death, medical or surgical complications), prolonged length of stay (pLOS), and 30-day readmission. We used logistic regression models to examine the association between race and ethnicity, surgical approach, and outcomes. We tested the interaction between racial/ethnic groups and surgical approach on multiplicative and additive scales.
Results: The analytical cohort included 18,926 patients (NHW 14,215(75.1%), NHB 3195(16.9%), Hispanic 1516(8.0%)). The average age was 60.4(SD=7.1) years. NHB and Hispanic patients were less likely to undergo RARP than NHW patients (NHW vs. NHB vs. Hispanic: 87.8% vs. 75.3% vs. 73.7%). NHB and Hispanic patients had higher risks of major events (5.7% vs. 8.1% vs. 8.2%) and pLOS (14.0% vs. 27.9% vs. 27.9%) than NHW patients. RARP was associated with reduced risks of major events (OR 0.28, 95% CI 0.21-0.38) and pLOS (OR 0.14, 95% CI 0.08-0.22). When assessing the interaction between race/ethnicity and procedure approach on the additive scale, the absolute reductions in the risks of major events and pLOS following RARP vs. ORP were larger among NHB (RERI and 95% CI: major events -0.32(-0.70,-0.01); pLOS: -0.64(-0.99,-0.36)) and Hispanic (RERI major events: -0.28(-0.74,0.09); pLOS: -0.93(-1.46,-0.53)) patients than among NHW patients. The interaction was absent on the multiplicative scale.
Conclusions: When compared to NHW men with prostate cancer, NHB and Hispanic men had lower prevalences of RARP use and experienced greater reductions in postoperative adverse events when using RARP vs. ORP. Increasing penetration of robot-assisted technology across racial groups may help reduce racial and ethnic disparities in patient outcomes after radical prostatectomy.
