Introduction
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common
cancer in the United States with 65,410 new diagnoses in 2019.(1) Over
the past three decades, HNSCC epidemiology has changed significantly due
to the rapidly increasing incidence of oropharyngeal squamous cell
carcinoma (OPSCC).(2) This is primarily driven by rising exposure to the
human papillomavirus (HPV) infection, which now accounts for 60-70% of
incident OPSCC cases.(3) Compared to HPV-negative OPSCC, the demographic
profile of patients with HPV-positive OPSCC tends to be younger, male,
white, and non-smokers.(3) It is estimated that there are 3,500 new
cases of HPV-associated OPSCC diagnosed in women and 15,500 in men each
year in the United States.(4) In the United States, white patients with
OPSCC are more likely than black patients to have HPV-positive tumors
(67.6% vs. 42.3%, respectively; p<0.001).(5) Most studies
evaluating the prognosis for patients with OPSCC have been composed of
primarily of white patients. To date, there is limited information
regarding the prognosis of black patients with HPV-associated OPSCC.
Racial disparities in HNSCC have been well described, but it is unknown
if these findings translate to HPV-associated OPSCC, which is now
recognized as a distinct clinicopathologic entity. Although black
patients account for a minority of all HNSCC cases, they contribute
disproportionately to the morbidity and mortality associated with this
disease.(6,7) Black HNSCC patients are diagnosed at more advanced
disease stage and have worse survival outcomes compared to white HNSCC
patients.(8–10) Previous studies have suggested that lower
socioeconomic status and differential access to care contribute to this
disparity.(11,12) Some studies have shown that the racial disparities in
HNSCC are largely driven by the OPSCC subsite, given that HPV-associated
disease is more prevalent in white patients and has better
prognosis.(13) However few studies have examined racial disparities in
OPSCC while also assessing the relative influence of HPV-status.
A recent systematic review of studies assessing racial disparities in OS
in OPSCC after adjusting for HPV-status (13) identified only 5 studies
in the current literature that examined survival disparities by race
after adjusting for HPV-status in OPSCC. None of these studies included
measures of SES in the adjustment set. Furthermore, only one study
included alcohol use in the adjustment set. These findings suggest that
HPV-status accounts for much of the racial disparity in OS for OPSCC,
but conclusions were limited by the small number of relevant studies and
narrow adjustment sets.
To address this gap in current literature we examined racial differences
in HPV-associated OPSCC outcomes using a population-based study with
information on individual level-SES, as well as comprehensive
demographic, clinical, and treatment variables. Previous studies
examining racial disparities have relied either on single-institution
data, clinical trial data, or cancer registry data, in which this
information was not available.