Benjamin William J, Patil Siddhi, Mohebbi Elham, Latif Sophia, Perera Chamila, Bellile Emily, Wang Kai, Sartor Maureen A, Taylor Jeremy M G, Wolf Gregory T, Chinn Steven B, Rozek Laura S
Department of Otolaryngology - Head and Neck Surgery, Mass Eye and Ear, Boston, MA, USA.
Department of Oncology, Georgetown University, 2115 Wisconsin Ave NW, Washington, DC, 20007, USA.
Cancer Causes Control. 2025 Sep 12. doi: 10.1007/s10552-025-02067-3.
To assess the impact of neighborhood-level disadvantage using the area disadvantage index (ADI) on survival outcomes in head and neck squamous cell carcinoma (HNSCC) patients.
Patients diagnosed with previously untreated HNSCC from a single institutional study at a large, tertiary care hospital between 2008 and 2014 were provided self-administered questionnaires in a prospective longitudinal cohort study. Area Deprivation Index (ADI) was the primary exposure of interest, calculated using Federal Information Processing Standard (FIPS) codes that assess a neighborhood's socioeconomic conditions, where a higher ADI indicates a disadvantaged neighborhood and lower socioeconomic status. The primary outcomes of interest were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). Survival outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazard models.
The study included 792 patients. Patients with a higher ADI score were more likely to live in a less populous area (p < 0.01) and have a higher comorbidity score (p < 0.01), were heavy smokers (p < 0.01), and most cases (80.8%) tested negative for Human Papillomavirus (HPV) infection (p < 0.01). Higher terciles of ADI were associated with lower 5-year OS (p < 0.01), DSS (p = 0.01), and RFS (p = 0.03), with each 10-point increase in ADI being associated with a 1.1 times increase in hazard of death, disease-specific death, or recurrence (p < 0.01 for all). Patients in the highest tercile of ADI had significantly higher hazards of death (HR: 1.8 [1.3, 2.4], p < 0.01) and recurrence (1.4 [1.1, 1.9], p = 0.04) compared to the lowest tercile. In multivariable models, ADI was not significantly associated with OS, DSS, or RFS. Predictors of OS and DSS included HPV, stage, age, BMI, pack years, and comorbidity score, while RFS was predicted by HPV, stage, and comorbidity.
Higher ADI scores were linked to poorer survival outcomes in HNSCC. These findings underscore the importance of considering social determinants of health, particularly ADI components like income, employment, housing quality, and access to care, in influencing HNSCC mortality and recurrence rates.
使用区域劣势指数（ADI）评估社区层面的劣势对头颈鳞状细胞癌（HNSCC）患者生存结局的影响。
在一项前瞻性纵向队列研究中，对2008年至2014年期间在一家大型三级护理医院进行的单机构研究中诊断为先前未接受治疗的HNSCC患者提供自我管理问卷。区域剥夺指数（ADI）是主要关注的暴露因素，使用联邦信息处理标准（FIPS）代码计算，该代码评估社区的社会经济状况，ADI越高表明社区处于劣势且社会经济地位越低。主要关注的结局是总生存期（OS）、疾病特异性生存期（DSS）和无复发生存期（RFS）。使用Kaplan-Meier分析和Cox比例风险模型评估生存结局。
该研究纳入了792例患者。ADI评分较高的患者更有可能居住在人口较少的地区（p < 0.01）且合并症评分较高（p < 0.01），是重度吸烟者（p < 0.01），并且大多数病例（80.8%）人乳头瘤病毒（HPV）感染检测为阴性（p < 0.01）。ADI较高的三分位数与较低的5年OS（p < 0.01）、DSS（p = 0.01）和RFS（p = 0.03）相关，ADI每增加10分，死亡、疾病特异性死亡或复发风险增加1.1倍（所有p < 0.01）。与最低三分位数相比，ADI最高三分位数的患者死亡风险（HR：1.8 [1.3, 2.4]，p < 0.01）和复发风险（1.4 [1.1, 1.9]，p = 0.04）显著更高。在多变量模型中，ADI与OS、DSS或RFS无显著关联。OS和DSS的预测因素包括HPV、分期、年龄、BMI、吸烟包年数和合并症评分，而RFS由HPV、分期和合并症预测。
较高的ADI评分与HNSCC患者较差的生存结局相关。这些发现强调了在影响HNSCC死亡率和复发率方面考虑健康的社会决定因素的重要性，特别是像收入、就业、住房质量和医疗服务可及性等ADI组成部分。
