Department of Biochemistry, Program in Cancer Cell Biology, West Virginia University Cancer Institute, West Virginia University, P.O. Box 9300, Morgantown, WV, 26506, USA.
Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, WV, 26506, USA.
Sci Rep. 2020 Jul 15;10(1):11612. doi: 10.1038/s41598-020-68380-w.
The United States Appalachian region harbors a higher cancer burden than the rest of the nation, with disparate incidence of head and neck squamous cell carcinomas (HNSCC), including oral cavity and pharynx (OC/P) cancers. Whether elevated HNSCC incidence generates survival disparities within Appalachia is unknown. To address this, HNSCC survival data for 259,737 tumors from the North American Association for Central Cancer Registries 2007-2013 cohort were evaluated, with age-adjusted relative survival (RS) calculated based on staging, race, sex, and Appalachian residence. Tobacco use, a primary HNSCC risk factor, was evaluated through the Behavioral Risk Factor Surveillance System from Appalachian states. Decreased OC/P RS was found in stage IV Appalachian white males within a subset of states. The survival disparity was confined to human papillomavirus (HPV)-associated oropharyngeal cancers, specifically the oropharynx subsite. This correlated with significantly higher smoking and male smokeless tobacco use in most Appalachian disparity states. Lower survival of Appalachian males with advanced-stage HPV-associated oropharyngeal cancers suggests pervasive tobacco consumption likely generates more aggressive tumors at HPV-associated oropharynx subsites than national averages. Comprehensive tobacco and HPV status should therefore be evaluated prior to considering treatment de-intensification regimens for HPV-associated oropharyngeal cancers in populations with high tobacco consumption.
美国阿巴拉契亚地区的癌症负担高于全国其他地区，头颈部鳞状细胞癌（HNSCC）的发病率存在差异，包括口腔癌和咽癌（OC/P）。在阿巴拉契亚地区，升高的 HNSCC 发病率是否会导致生存差异尚不清楚。为了解决这个问题，评估了北美癌症登记协会 2007-2013 年队列中 259737 例肿瘤的 HNSCC 生存数据，并根据分期、种族、性别和阿巴拉契亚地区的居住情况计算了年龄调整后的相对生存率（RS）。通过阿巴拉契亚州的行为风险因素监测系统评估了主要的 HNSCC 风险因素烟草使用情况。在一些州的亚组中，发现阿巴拉契亚地区白人男性 IV 期 OC/P 的 RS 降低。生存差异仅限于 HPV 相关的口咽癌，特别是口咽亚部位。这与大多数阿巴拉契亚差异州中明显较高的吸烟和男性嚼烟使用相关。晚期 HPV 相关口咽癌阿巴拉契亚男性的生存率较低表明，与全国平均水平相比，普遍的烟草消费可能在 HPV 相关口咽亚部位产生更具侵袭性的肿瘤。因此，在考虑为高烟草消费人群的 HPV 相关口咽癌治疗减量化方案之前，应评估全面的烟草和 HPV 状况。
