Department of Otolaryngology, Washington University School of Medicine, St Louis, MO, United States; Division of Public Health Sciences, Department of Surgery, Washington University, St Louis, MO, United States.
Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States.
Oral Oncol. 2021 Jan;112:105093. doi: 10.1016/j.oraloncology.2020.105093. Epub 2020 Nov 21.
Gender and race disparities in head and neck squamous cell carcinoma (HSNCC) survival are independently well documented, but no prior studies have examined the joint effect of these factors on HSNCC outcomes. We aim to comprehensively estimate the effect of gender and race on overall survival in HNSCC. We constructed a retrospective cohort from the National Cancer Database for primary HNSCC of the larynx, hypopharynx, oral cavity, and oropharynx from 2010 to 2015. We used Kaplan-Meier curves and Cox proportional hazards regressions to calculate hazard ratios adjusting for treatment type, age, insurance, staging classifications, and comorbidities. Oral cavity cancer was significantly more common among Hispanic and White females compared to other sites. Female non-oropharyngeal HNSCC cases had better five-year overall survival than males (56.3% versus 54.4%, respectively), though Black females (52.8%) had poorer survival than both White (56.2%) and Hispanic (57.9%) males. There were significant differences in oropharyngeal cancer by HPV status. Notably, Black females with HPV-positive oropharyngeal OPSCC had far worse survival than any other race and gender group. These results persisted even when adjusting for potential mediating factors. Clearly gender is a significant prognosticator for HNSCC and has meaningful interactions with race. The distinct site distributions across gender and race reveal important insights into HNSCC among females. Taking into account these gender disparities while considering race is essential to providing appropriate care to head and neck patients and accurately counselling these individuals on prognosis and outcomes.
性别和种族在头颈部鳞状细胞癌（HSNCC）生存中的差异已得到充分记录，但以前没有研究检查这些因素对 HSNCC 结果的联合影响。我们旨在全面估计性别和种族对头颈部鳞状细胞癌总生存率的影响。我们从 2010 年至 2015 年国家癌症数据库中构建了一个原发于喉、下咽、口腔和口咽的 HNSCC 回顾性队列。我们使用 Kaplan-Meier 曲线和 Cox 比例风险回归来计算风险比，调整治疗类型、年龄、保险、分期分类和合并症。与其他部位相比，西班牙裔和白人女性口腔癌的发病率明显更高。女性非口咽 HNSCC 病例的五年总生存率优于男性（分别为 56.3%和 54.4%），而黑人女性（52.8%）的生存率低于白人（56.2%）和西班牙裔（57.9%）男性。HPV 状态对口咽癌有显著影响。值得注意的是，HPV 阳性口咽 OPSCC 的黑人女性的生存率远低于任何其他种族和性别群体。即使在调整潜在的中介因素后，这些结果仍然存在。显然，性别是 HNSCC 的一个重要预后因素，与种族有显著的相互作用。性别和种族之间不同的部位分布揭示了女性 HSNCC 的重要见解。在考虑种族的同时考虑这些性别差异，对于为头颈部患者提供适当的护理以及准确地向这些个体提供预后和结果咨询至关重要。
