Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
J Natl Compr Canc Netw. 2020 Feb;18(2):177-184. doi: 10.6004/jnccn.2019.7356.
Socioeconomic factors affecting outcomes of HPV-associated squamous cell carcinoma of the head and neck (SCCHN) are poorly characterized.
A custom SEER database identified adult patients with primary nonmetastatic SCCHN and known HPV status diagnosed in 2013 through 2014. Multivariable logistic regression defined associations between patient characteristics and HPV status, with adjusted odds ratios (aORs) and 95% confidence intervals reported. Fine-Gray competing risks regression estimated adjusted hazard ratios (aHRs) and 95% confidence intervals for cancer-specific mortality (CSM), including a disease subsite * HPV status * race interaction term.
A total of 4,735 patients with nonmetastatic SCCHN and known HPV status were identified. HPV-associated SCCHN was positively associated with an oropharyngeal primary, male sex, and higher education, and negatively associated with uninsured status, single marital status, and nonwhite race (P≤.01 for all). For HPV-positive oropharyngeal SCCHN, white race was associated with lower CSM (aHR, 0.55; 95% CI, 0.34-0.88; P=.01) and uninsured status was associated with higher CSM (aHR, 3.12; 95% CI, 1.19-8.13; P=.02). These associations were not observed in HPV-negative or nonoropharynx SCCHN. Accordingly, there was a statistically significant disease subsite * HPV status * race interaction (Pinteraction<.001).
Nonwhite race and uninsured status were associated with worse CSM in HPV-positive oropharyngeal SCCHN, whereas no such associations were observed in HPV-negative or nonoropharyngeal SCCHN. These results suggest that despite having clinically favorable disease, nonwhite patients with HPV-positive oropharyngeal SCCHN have worse outcomes than their white peers. Further work is needed to understand and reduce socioeconomic disparities in SCCHN.
影响 HPV 相关头颈部鳞状细胞癌 (SCCHN) 结局的社会经济因素尚未得到充分描述。
定制 SEER 数据库确定了 2013 年至 2014 年间诊断为原发性非转移性 SCCHN 且已知 HPV 状态的成年患者。多变量逻辑回归定义了患者特征与 HPV 状态之间的关联，并报告了调整后的优势比 (aOR) 和 95%置信区间。精细灰色竞争风险回归估计了癌症特异性死亡率 (CSM) 的调整后的危险比 (aHR) 和 95%置信区间，包括疾病部位 * HPV 状态 * 种族相互作用项。
共确定了 4735 例患有非转移性 SCCHN 且已知 HPV 状态的患者。HPV 相关 SCCHN 与口咽原发性疾病、男性性别和较高的教育程度呈正相关，与未参保状态、单身婚姻状况和非白人种族呈负相关 (所有 P 值均<.01)。对于 HPV 阳性的口咽 SCCHN，白人种族与较低的 CSM 相关 (aHR，0.55；95%CI，0.34-0.88；P=.01)，未参保状态与较高的 CSM 相关 (aHR，3.12；95%CI，1.19-8.13；P=.02)。这些关联在 HPV 阴性或非口咽 SCCHN 中并未观察到。因此，存在统计学显著的疾病部位 * HPV 状态 * 种族相互作用 (P 交互<.001)。
非白人种族和未参保状态与 HPV 阳性的口咽 SCCHN 患者的 CSM 较差相关，而在 HPV 阴性或非口咽 SCCHN 中未观察到这种关联。这些结果表明，尽管 HPV 阳性的口咽 SCCHN 患者具有临床有利的疾病特征，但他们的结局仍不如白人患者。需要进一步的工作来了解和减少 SCCHN 中的社会经济差异。
