Walsh Amanda R, Giurintano Jonathan P, Maxwell Jessica H, Shah Anuja H, Haupt Thomas L, Wadley Andrew E, Kowkuntla Sandeep R, Habib Andy M, Shah Veranca
Department of Otolaryngology-Head and Neck Surgery MedStar Georgetown University Hospital Washington District of Columbia USA.
Department of Otolaryngology-Head and Neck Surgery District of Columbia Veteran's Affairs Medical Center Washington District of Columbia USA.
OTO Open. 2024 Jun 11;8(2):e150. doi: 10.1002/oto2.150. eCollection 2024 Apr-Jun.
There is limited data on the impact of clinical-demographic factors on survival outcomes among veterans with head and neck squamous cell carcinoma (HNSCC). This study was undertaken to evaluate the impact of race and other factors on overall survival (OS) in a population of veterans with HNSCC treated with curative intent.
Demographic and clinical data were collected on veterans with HNSCC treated with curative intent at our institution between 1999 and 2021. The primary outcome was 3-year OS. Secondary outcomes included treatment delay intervals, including time to treatment initiation (TTI), total package time, and duration of chemoradiation (DCRT).
Of 260 veterans with HNSCC, black veterans had significantly lower 3-year OS (49.4%) compared to white veterans (65%, = .019). Black veterans were also more likely to experience delays in treatment initiation (median TTI 46 vs 41 days; = .047). Black patients were more likely to receive radiation alone (25.8% [black] vs 8.4% [white]; < .001) and less likely to receive adjuvant therapy if treated surgically (11.1% [black] vs 22.4% [white]; = .004), despite any statistically significant difference in stage of their tumor at presentation (Stage I: 21.2% [black] vs 19.6% [white]; = .372); (Stage IV: 44.4% [black] vs 48.6% [white]; = .487). Other factors associated with worse 3-year OS included older age ( = .023), lower body mass index ( = .026), neurocognitive disorder/dementia ( = .037), mental health disorders ( = .020), hypopharyngeal primary ( = .001), higher stage disease ( = .002), treatment type ( = .001), need for prophylactic gastrostomy tube ( = .048) or tracheotomy ( = .005), recurrent disease ( = .036), persistent disease ( < .001), distant metastases ( = .002), longer TTI ( = .0362), and longer DCRT ( = .004).
Black race appears to be an independent predictor of 3-year OS in veterans with HNSCC. Further studies are warranted to determine the factors responsible for disparities in survival.
This study evaluated the ways in which race affects survival for US veterans with head and neck cancer. The authors found that black veterans had an increased risk of death compared to white patients, and also experienced delays when receiving treatment.
Level IV.
关于临床人口统计学因素对头颈鳞状细胞癌（HNSCC）退伍军人生存结局的影响，数据有限。本研究旨在评估种族和其他因素对接受根治性治疗的HNSCC退伍军人总体生存（OS）的影响。
收集了1999年至2021年间在我们机构接受根治性治疗的HNSCC退伍军人的人口统计学和临床数据。主要结局是3年总生存率。次要结局包括治疗延迟间隔，包括开始治疗时间（TTI）、总疗程时间和放化疗持续时间（DCRT）。
在260例HNSCC退伍军人中，黑人退伍军人的3年总生存率（49.4%）显著低于白人退伍军人（65%，P = 0.019）。黑人退伍军人也更有可能经历治疗开始延迟（中位TTI为46天对41天；P = 0.047）。黑人患者更有可能仅接受放疗（25.8%[黑人]对8.4%[白人]；P < 0.001），并且如果接受手术治疗，接受辅助治疗的可能性较小（11.1%[黑人]对22.4%[白人]；P = 0.004），尽管其就诊时肿瘤分期无统计学显著差异（I期：21.2%[黑人]对19.6%[白人]；P = 0.372）；（IV期：44.4%[黑人]对48.6%[白人]；P = 0.487）。与较差的3年总生存率相关的其他因素包括年龄较大（P = 0.023）、体重指数较低（P = 0.026）、神经认知障碍/痴呆（P = 0.037）、精神健康障碍（P = 0.020）、下咽原发癌（P = 0.001）、疾病分期较高（P = 0.002）、治疗类型（P = 0.001）、需要预防性胃造瘘管（P = 0.048）或气管切开术（P = 0.005）、复发疾病（P = 0.036）、持续性疾病（P < 0.001）、远处转移（P = 0.002）、较长的TTI（P = 0.0362）和较长的DCRT（P = 0.004）。
黑人种族似乎是HNSCC退伍军人3年总生存率的独立预测因素。有必要进行进一步研究以确定导致生存差异的因素。
本研究评估了种族影响美国头颈癌退伍军人生存的方式。作者发现，与白人患者相比，黑人退伍军人死亡风险增加，并且在接受治疗时也经历延迟。
IV级。
