Oropharyngeal cancer as a driver of racial outcome disparities in squamous cell carcinoma of the head and neck: 10‐year experience at the University of Maryland Greenebaum Cancer Center

Abstract

Background Racial outcome disparities have been observed in HNSCC with diminished survival for black patients compared to whites. Methods We retrospectively analyzed 1318 patients with primary HNSCC treated at the UMGCC from 2000 to 2010. Results 65.9% were white, 30.7% were black and 3.3% were of other races. Blacks were less likely to present with oral cavity cancer (OC), and more likely to present with laryngeal or hypopharyngeal cancers. Whites were more likely to have early stage disease, especially in the OC. Black race was independently associated with worse OS in the entire cohort. Blacks had a significantly worse OS amongst OC and oropharyngeal cancers (OPC), with the largest disparity in OPC. However in multivariate analysis race was only still significant in OPC. Conclusion We observed differences by race in distribution of disease site, stage, and OS. Survival disparity in the entire cohort was driven mostly by differences amongst OPC.

Racial differences in head and neck squamous cell carcinomas among non-Hispanic black and white males identified through the National Cancer Database (1998–2012)

“…Compared to nH white males, nH blacks had a higher incidence of non-oropharyngeal tumors, as well as locoregional and distant tumors, all of which are indicative of more aggressive and advanced disease. These results are consistent with regional studies of nH black and white males and females that reported higher percentages of locoregional (Gourin and Podolsky 2006;Zandberg et al 2014) and distant (Daraei and Moore 2014;Ragin et al 2011) stages in nH blacks. Similar to findings across study populations (Betiol et al 2013;Chaturvedi et al 2008;Ryerson et al 2008), the majority of HPV types within NCDB were type 16 or types 16/18 combined.…”

“…The study's large sample spans 14 years and includes cases from all regions of the US, allowing for a comprehensive assessment of primary anatomical sites, clinical factors, and temporal trends in HNSCCs among nH black and white males. Our results expand on both previous studies using SEER data (Shiboski et al 2007), which do not adequately reflect geographic diversity (Data 18-Mar-2009), and on smaller localized studies (Gourin and Podolsky 2006;Jiron et al 2014;Zandberg et al 2014), which do not allow for evaluation of temporal trends in HNSCCs or for comprehensive analyses of primary anatomical sites.…”

“…The higher incidence of more advanced and aggressive HNSCCs among nH black males at the time of diagnosis likely contributes to their survival disadvantage relative to nH white males. HPV-related HNSCCs have a significantly better prognoses than those associated with smoking and alcohol (Zandberg et al 2015), and the racial differences in HPV observed in NCDB cases may also partly explain the survival disadvantage observed in nH black males (Gourin and Podolsky 2006;Shiboski et al 2007;Zandberg et al 2014). Future studies are needed to better understand the factors that contribute to racial differences in primary anatomical site, stage, and factors associated with HPV-related HNSCCs.…”

“…However, there is evidence in the literature that although smoking has decreased in nH blacks (Blackwell et al 2014;Jiron et al 2014), it remains higher in nH black males compared to nH white males (Zandberg et al 2014). Additionally, among HNSCC cases, heavy alcohol consumption is greater in nH black males than in nH white males (Gourin and Podolsky 2006;Stingone et al 2013).…”

Prevalence of HPV infection in racial–ethnic subgroups of head and neck cancer patients

“…In the United States (US), a clear disparity in HNC survival has been reported between Black and White patients, particularly for oropharyngeal cancers. Poor survival rates for Black Americans compared to White Americans have been observed (7), and some studies have suggested that this disparity may be explained at least partially by a difference in prevalence of HPV infection (8)(9)(10).…”