Baliga Sujith, Yildiz Vedat O, Bazan Jose, Palmer Joshua D, Jhawar Sachin R, Konieczkowski David J, Grecula John, Blakaj Dukagjin M, Mitchell Darrion, Henson Christina, Hu Kenneth, Yamoah Kosj, Gamez Mauricio E
Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Department of Radiation Oncology, Oklahoma University Health Stephenson Cancer Center, Oklahoma City, OK 73104, USA.
Cancers (Basel). 2023 Mar 15;15(6):1781. doi: 10.3390/cancers15061781.
Racial/ethnic (R/E) minorities with head and neck squamous cell carcinoma (HNSCC) have worse survival outcomes compared to White patients. While disparities in patient outcomes for R/E minorities have been well documented, the specific drivers of the inferior outcomes remain poorly understood.
This was a population-based retrospective cohort study that analyzed HNSCC patients using the National Cancer Database (NCDB) from 2000-2016. Patient outcomes were stratified by R/E groups including White, Black, Hispanic, Native American/Other, and Asian. The main outcome in this study was overall survival (OS). Univariate time-to-event survival analyses were performed using the Kaplan-Meier product limit estimates and the log-rank test to evaluate the differences between strata.
There were 304,138 patients with HNSCC identified in this study, of which 262,762 (86.3%) were White, 32,528 (10.6%) were Black, 6191 were Asian (2.0%), and 2657 were Native American/Other (0.9%). Black R/E minorities were more likely to be uninsured (9% vs. 5%, < 0.0001), have Medicaid insurance (22% vs. 8%, < 0.0001), be in a lower income quartile (<30,000, 42% vs. 13%, < 0.0001), have metastatic disease (5% vs. 2%, < 0.001), and have a total treatment time 6 days longer than White patients (median 107 vs. 101 days, < 0.001). The 5-year OS for White, Black, Native American/Other, and Asian patients was 50.8%, 38.6%, 51.1%, and 55.8%, respectively. Among the oropharynx HNSCC patients, the 5-year OS rates in p16+ White, Black, and Asian patients were 65.7%, 39.4%%, and 55%, respectively. After a multivariate analysis, Black race was still associated with an inferior OS (HR:1.09, 95% CI: 1.03-1.15, = 0.002).
This large cohort study of HNSCC patients demonstrates that Black race is independently associated with worse OS, in part due to socioeconomic, clinical, and treatment-related factors.
与白人患者相比，头颈部鳞状细胞癌（HNSCC）的种族/族裔（R/E）少数群体的生存结果更差。虽然R/E少数群体患者结局的差异已有充分记录，但较差结局的具体驱动因素仍知之甚少。
这是一项基于人群的回顾性队列研究，使用2000 - 2016年国家癌症数据库（NCDB）分析HNSCC患者。患者结局按R/E群体分层，包括白人、黑人、西班牙裔、美洲原住民/其他和亚洲人。本研究的主要结局是总生存期（OS）。使用Kaplan-Meier乘积限估计和对数秩检验进行单变量事件时间生存分析，以评估各层之间的差异。
本研究共纳入304,138例HNSCC患者，其中262,762例（86.3%）为白人，32,528例（10.6%）为黑人，6191例（2.0%）为亚洲人，2657例（0.9%）为美洲原住民/其他。黑人R/E少数群体更有可能未参保（9%对5%，<0.0001）、拥有医疗补助保险（22%对8%，<0.0001）、处于较低收入四分位数（<30,000，42%对13%，<0.0001）、患有转移性疾病（5%对2%，<0.001），且总治疗时间比白人患者长6天（中位107天对101天，<0.001）。白人、黑人、美洲原住民/其他和亚洲患者的5年总生存率分别为50.8%、38.6%、51.1%和55.8%。在口咽HNSCC患者中，p16+白人、黑人和亚洲患者的5年总生存率分别为65.7%、39.4%和55%。多变量分析后，黑人种族仍与较差的总生存期相关（HR：1.09，95%CI：1.03 - 1.15，P = 0.002）。
这项对HNSCC患者的大型队列研究表明，黑人种族与较差的总生存期独立相关，部分原因是社会经济、临床和治疗相关因素。
