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Decreased overall survival in black patients with HPV-associated oropharyngeal cancer
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  • Siddharth Sheth,
  • Douglas Farquhar,
  • Nicholas Lenze,
  • Angela Mazul,
  • Paul Brennan,
  • Devasena Anantharaman ,
  • Behnoush Abedi-Ardekani ,
  • Jose Zevallos,
  • Neil Hayes,
  • Andrew F. Olshan
Siddharth Sheth
University of North Carolina at Chapel Hill School of Medicine
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Douglas Farquhar
University of North Carolina at Chapel Hill School of Medicine
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Nicholas Lenze
University of North Carolina at Chapel Hill School of Medicine
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Angela Mazul
Washington University in Saint Louis School of Medicine
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Paul Brennan
International Agency for Research on Cancer
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Devasena Anantharaman
International Agency for Research on Cancer
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Behnoush Abedi-Ardekani
International Agency for Research on Cancer
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Jose Zevallos
Washington University in Saint Louis School of Medicine
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Neil Hayes
The University of Tennessee Health Science Center
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Andrew F. Olshan
University of North Carolina System
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Abstract

Abstract Introduction: Racial disparities for overall survival (OS) in head and neck cancer have been well described. However, the extent to which these disparities exist for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), and the contribution of demographic, clinical, and socioeconomic status (SES) variables, is unknown. Methods: Patients were identified from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE), a population-based study in North Carolina. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for OS in black versus white patients with sequential adjustment sets. Results: A total of 157 HPV-associated OPSCC patients were identified. Of these, 93% were white and 7% were black. Black patients with HPV-associated OPSCC were more likely to be younger, have an income <$20,000, live farther away from clinic where biopsy was performed, and have advanced T stage at diagnosis. Black patients had worse OS in the unadjusted analysis (HR 4.9, 95% CI 2.2-11.1, p<0.0001). The racial disparity in OS slightly decreased when sequentially adjusting for demographic, clinical, and SES variables. However, HR for black race remained statistically elevated in the final adjustment set which controlled for age, sex, stage, smoking, alcohol use, and individual-level household income, insurance, and education level (HR 3.4, 95% CI 1.1-10.1, p=0.028). Conclusion: This is the first population-based study that confirms persistence of racial disparities in HPV-associated OPSCC after controlling for demographic, clinical, and individual-level socioeconomic factors. Keywords: Head and neck neoplasms, disparities, race, survival, human papillomavirus, epidemiology

Peer review status:Published

Jan 2021Published in American Journal of Otolaryngology volume 42 issue 1 on pages 102780. 10.1016/j.amjoto.2020.102780