Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
University Hospitals Seidman Cancer Center, Cleveland, OH.
JCO Oncol Pract. 2021 May;17(5):e695-e702. doi: 10.1200/OP.20.01105.
Human papilloma virus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), diagnosed with p16 immunohistochemistry, is associated with favorable prognosis; however, this connection was established using European American (EA)-skewed populations. The impact of p16/human papillomavirus status on outcomes in African American (AA) OPSCC patients remains to be settled. In this study, we determine the association between cancer disparity and p16 status in an OPSCC cohort controlling for time to treatment initiation (TTI), a surrogate for medical care access.
We analyzed data from all patients diagnosed with OPSCC (N = 440) between 2010 and 2017, who received treatment at our academic medical center. Associations between age, disease stage, sex, p16 status, race, TTI, and overall survival (OS) were investigated.
TTI was similar between AA and EA OPSCC patients in our p16+ ( = .291) or p16- ( = .715) cohorts. Among p16+ OPSCC patients, the median OS was > 8.65 years for EA patients compared with 5.038 years (95% CI, 2.019 to 5.30; = .003, log-rank) for AA patients. For p16- patients, the median OS was 5.74 years (95% CI, 3.32 to 6.99) for EA patients and 1.85 years (95% CI, 0.978 to 4.50; = .03, log-rank) for AA patients. Multivariate Cox regression analysis showed that race was an independent prognostic biomarker and the most impactful co-variate for OS (hazard ratio, 0.40; 95% CI, 0.00 to 0.69; = .001).
Our work showed that AAs with p16+ OPSCC have surprisingly poor clinical outcomes and are thus poor candidates for treatment de-escalation regimens. Caution should be exercised when extending clinical guidelines based on EA-majority studies to non-EA populations.
人乳头瘤病毒阳性（HPV+）口咽鳞状细胞癌（OPSCC），通过 p16 免疫组化诊断，与良好的预后相关；然而，这一关联是基于欧洲裔美国人（EA）为主的人群建立的。p16/人乳头瘤病毒状态对非裔美国人（AA）OPSCC 患者结局的影响仍有待解决。在这项研究中，我们通过控制治疗开始时间（TTI），即医疗保健获取的替代指标，来确定 OPSCC 队列中癌症差异与 p16 状态之间的关联。
我们分析了 2010 年至 2017 年间在我们学术医疗中心接受治疗的所有 OPSCC 患者（N=440）的数据。研究了年龄、疾病分期、性别、p16 状态、种族、TTI 和总生存（OS）之间的关联。
在我们的 p16+（ =.291）或 p16-（ =.715）队列中，AA 和 EA OPSCC 患者的 TTI 相似。在 p16+OPSCC 患者中，EA 患者的中位 OS 超过 8.65 年，而 AA 患者为 5.038 年（95%CI，2.019 至 5.30； =.003，对数秩）。对于 p16-患者，EA 患者的中位 OS 为 5.74 年（95%CI，3.32 至 6.99），AA 患者为 1.85 年（95%CI，0.978 至 4.50； =.03，对数秩）。多变量 Cox 回归分析显示，种族是独立的预后生物标志物，也是 OS 最具影响力的协变量（风险比，0.40；95%CI，0.00 至 0.69； =.001）。
我们的工作表明，p16+OPSCC 的 AA 患者临床结局出人意料地差，因此不太适合进行治疗降级方案。在将基于 EA 为主的研究制定的临床指南推广到非 EA 人群时应谨慎。
