Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA.
Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
JCO Oncol Pract. 2021 Mar;17(3):e313-e322. doi: 10.1200/OP.20.00671. Epub 2021 Jan 12.
Human papilloma virus (HPV) association remains one of the most important predictors of clinical outcome in oropharyngeal squamous cell carcinoma (OPSCC). We aimed to determine whether the relationship between HPV status and overall survival was influenced by socioeconomic factors.
Using the National Cancer Database, we examined the relationship between socioeconomic status and overall survival, controlling for demographics and socioeconomic variables (age at diagnosis, race, sex, clinical stage, facility type, facility location, insurance status, median-income quartiles, percent of no high-school education quartiles, rural-urban dwelling, Charlson-Deyo score, primary site, and treatment type).
HPV-positive patients with private insurance have improved overall survival compared with HPV-positive patients who are uninsured (hazard ratio [HR], 0.51, 95% CI, 0.41 to 0.63, < .001). HPV-negative patients with private insurance have improved overall survival compared with HPV-negative patients who were uninsured (HR, 0.62, 95% CI, 0.53 to 0.73, < .001). HPV-positive patients living in the south had improved overall survival compared with HPV-positive patients living in the west (HR, 0.83, 95% CI, 0.72 to 0.96, = .013). As assessed through interaction, relationships between survival and insurance ( = .004), rural-urban status ( = .009), and facility location ( = .021) statistically differed between HPV-positive and HPV-negative patients.
HPV status impact on overall survival for patients with OPSCC is influenced by socioeconomic factors including insurance status and treatment facility. A deeper understanding of these interactions is needed to improve equity of care for patients with OPSCC.
人乳头瘤病毒（HPV）的感染仍然是口咽鳞状细胞癌（OPSCC）临床转归最重要的预测因素之一。我们旨在确定 HPV 状态与总生存之间的关系是否受到社会经济因素的影响。
我们使用国家癌症数据库，研究了社会经济地位与总生存之间的关系，同时控制了人口统计学和社会经济变量（诊断时的年龄、种族、性别、临床分期、医疗机构类型、医疗机构位置、保险状况、中位收入四分位数、无高中教育比例四分位数、城乡居住、Charlson-Deyo 评分、原发部位和治疗类型）。
有私人保险的 HPV 阳性患者的总生存情况优于无保险的 HPV 阳性患者（风险比 [HR]，0.51，95%置信区间，0.41 至 0.63， <.001）。有私人保险的 HPV 阴性患者的总生存情况优于无保险的 HPV 阴性患者（HR，0.62，95%置信区间，0.53 至 0.73， <.001）。居住在南部的 HPV 阳性患者的总生存情况优于居住在西部的 HPV 阳性患者（HR，0.83，95%置信区间，0.72 至 0.96， =.013）。通过交互作用评估，生存与保险（ =.004）、城乡状态（ =.009）和医疗机构位置（ =.021）之间的关系在 HPV 阳性和 HPV 阴性患者之间存在统计学差异。
OPSCC 患者 HPV 状态对总生存的影响受到社会经济因素的影响，包括保险状况和治疗机构。需要更深入地了解这些相互作用，以提高 OPSCC 患者的护理公平性。
