Decreased overall survival in black patients with HPV-associated
oropharyngeal cancer
Abstract
Abstract Introduction: Racial disparities for overall survival (OS) in
head and neck cancer have been well described. However, the extent to
which these disparities exist for HPV-associated oropharyngeal squamous
cell carcinoma (OPSCC), and the contribution of demographic, clinical,
and socioeconomic status (SES) variables, is unknown. Methods: Patients
were identified from the Carolina Head and Neck Cancer Epidemiology
Study (CHANCE), a population-based study in North Carolina. Cox
proportional hazards regression models were used to estimate hazard
ratios (HR) and 95% confidence intervals (CI) for OS in black versus
white patients with sequential adjustment sets. Results: A total of 157
HPV-associated OPSCC patients were identified. Of these, 93% were white
and 7% were black. Black patients with HPV-associated OPSCC were more
likely to be younger, have an income <$20,000, live farther
away from clinic where biopsy was performed, and have advanced T stage
at diagnosis. Black patients had worse OS in the unadjusted analysis (HR
4.9, 95% CI 2.2-11.1, p<0.0001). The racial disparity in OS
slightly decreased when sequentially adjusting for demographic,
clinical, and SES variables. However, HR for black race remained
statistically elevated in the final adjustment set which controlled for
age, sex, stage, smoking, alcohol use, and individual-level household
income, insurance, and education level (HR 3.4, 95% CI 1.1-10.1,
p=0.028). Conclusion: This is the first population-based study that
confirms persistence of racial disparities in HPV-associated OPSCC after
controlling for demographic, clinical, and individual-level
socioeconomic factors. Keywords: Head and neck neoplasms, disparities,
race, survival, human papillomavirus, epidemiology