Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Am J Otolaryngol. 2021 Jan-Feb;42(1):102780. doi: 10.1016/j.amjoto.2020.102780. Epub 2020 Oct 22.
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.
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.
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).
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.
头颈部癌的总体生存（OS）的种族差异已有详细描述。然而，HPV 相关口咽鳞状细胞癌（OPSCC）的这些差异的程度以及人口统计学、临床和社会经济地位（SES）变量的贡献尚不清楚。
患者是从北卡罗来纳州的一项基于人群的 Carolina Head and Neck Cancer Epidemiology Study（CHANCE）中确定的。使用 Cox 比例风险回归模型来估计 OS 在黑人与白人 HPV 相关 OPSCC 患者中的风险比（HR）和 95%置信区间（CI），并进行连续调整集。
共确定了 157 例 HPV 相关 OPSCC 患者。其中，93%为白人，7%为黑人。HPV 相关 OPSCC 的黑人患者更年轻，收入低于 20,000 美元，距离进行活检的诊所更远，诊断时 T 期更晚期。在未调整分析中，黑人患者的 OS 较差（HR 4.9，95%CI 2.2-11.1，p<0.0001）。当按顺序调整人口统计学、临床和 SES 变量时，OS 种族差异略有减少。然而，在最终调整组中，控制年龄、性别、分期、吸烟、饮酒和个体家庭收入、保险和教育水平后，黑人种族的 HR 仍然统计学上升高（HR 3.4，95%CI 1.1-10.1，p=0.028）。
这是第一项基于人群的研究，证实了在控制人口统计学、临床和个体 SES 因素后，HPV 相关 OPSCC 中仍存在种族差异。
