Survival Disparities in Bladder, Kidney, and Prostate Cancer in Asian-Indian & Pakistani Immigrants to the United States as Compared to Other US Ethnic Groups: A Surveillance, Epidemiology and End Result (SEER) 2011 Public Use Database Study

Abstract

Objective: To compare the SEER 2011 public use data prognostic variables and survival of US Asian-Indians and Pakistanis (US-AIP) diagnosed with bladder, kidney, or prostate cancers, to patients in three comparable US ethnic groups (African-Americans, Hispanics, and Caucasians) diagnosed with the same cancers. Patients and Methods: SEER 1988-to-2008 data (released in 2011) was analyzed using SEER*Stat Software V7.0.5 and SAS version 9.3. Results: From 1988-to-2008, SEER documented 14,006 cancers in US-AIP (7,118 male, 6,888 female), with 2,867 (20%) being bladder, kidney, or prostate. Compared to the three other US ethnic groups examined, US-AIP genitourinary (GU) cancers occurred at significantly younger ages (p <0.01-to-<0.001). US-AIP had significantly more grade 3-4 (p <0.01-to-<0.001) and stage 3-4 (p<0.001) cancers than the other three groups. Paradoxically, despite having worse prognostic factors, five year age-adjusted survival for the bladder, kidney, and prostate cancers in US-AIP were significantly better than in the other three US ethnic groups (p <0.01-to-<0.001). Conclusions: SEER 1988-to-2008 data contained a “survival disconnect” for genitourinary cancers in US-AIP. All three US-AIP GU cancers had worse prognostic features but better age-adjusted survival when compared to three other US ethnic groups, even though US-AIP appeared to have had similar treatment. US-AIP cultural and biologic factors, which might modify the clinical behavior of their GU cancers, are discussed. Of note, SEER 2000-to-2008 data showed a significant decline in bladder, kidney, and prostate cancer relative risk of death for all four ethnic groups studied versus earlier era SEER 1994-to-2000 data.