Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Cancer Med. 2023 Apr;12(8):9976-9987. doi: 10.1002/cam4.5726. Epub 2023 Feb 27.
HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to experience inferior outcomes. We aim to understand how the emergence of HPV has impacted race and SES survival disparities in OPSCC.
A retrospective cohort of 18,362 OPSCC cases from 2010 to 2017 was assembled using the SEER (Surveillance, Epidemiology, and End Results) database. Cox proportional regression and Fine and Gray regression models were used to calculate hazard ratios (HRs) adjusting for race, SES, age, subsite, stage, and treatment.
Black patients had lower overall survival than patients of other races in HPV-positive and HPV-negative OPSCC (HR 1.31, 95% CI 1.13-1.53 and HR 1.23, 95% CI 1.09-1.39, respectively). Higher SES was associated with improved survival in all patients. Race had a diminished association with survival among high SES patients. Low SES Black patients had considerably worse survival than low SES patients of other races.
Race and SES interact variably across cohorts. High SES was protective of the negative effects of race, although there remains a disparity in outcomes among Black and non-Black patients, even in high SES populations. The persistence of survival disparities suggests that the HPV epidemic has not improved outcomes equally across all demographic groups.
HPV 相关口咽鳞状细胞癌（OPSCC）的预后较好，但有色人种和社会经济地位较低（SES）的患者的预后仍然较差。我们旨在了解 HPV 的出现如何影响 OPSCC 中种族和 SES 生存差异。
使用 SEER（监测、流行病学和最终结果）数据库，我们组建了一个由 2010 年至 2017 年的 18,362 例 OPSCC 病例组成的回顾性队列。我们使用 Cox 比例风险回归和 Fine 和 Gray 回归模型，计算了调整种族、SES、年龄、部位、分期和治疗因素后的风险比（HR）。
在 HPV 阳性和 HPV 阴性的 OPSCC 中，黑人患者的总生存率均低于其他种族的患者（HR 1.31，95%CI 1.13-1.53 和 HR 1.23，95%CI 1.09-1.39）。所有患者中，SES 较高与生存率提高相关。在 SES 较高的患者中，种族与生存率的关联减弱。SES 较低的黑人患者的生存率明显差于 SES 较低的其他种族患者。
种族和 SES 在不同队列中的相关性不同。SES 较高可保护种族的负面影响，但黑人和非黑人患者的结局仍存在差异，即使在 SES 较高的人群中也是如此。生存差异的持续存在表明，HPV 流行并未使所有人群的预后平等改善。
