Case-matching analysis of head and neck squamous cell carcinoma in racial and ethnic minorities in the United States--possible role for human papillomavirus in survival disparities

Abstract

Background: Several studies have documented disparities in head and neck cancer outcomes for black patients in the United States. Recent studies have found that differences in oropharyngeal tumor human papillomavirus (HPV) status may be a cause of this disparity.

Methods: In all, 76,817 cases of head and neck squamous cell carcinoma (HNSCC) recorded in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program were analyzed. Racial/ethnic groups were studied, for disease-specific survival in both case-matched and nonmatched cohorts. Calculation of expected disparity magnitudes based on HPV status was performed using data reported in the literature.

Results: A disease-specific survival disparity was demonstrated for Hispanic patients. However, case matching eliminated this disparity. Conversely, the disparity for black patients persisted in matched cohorts. The oropharyngeal subsite was found to be the dominant contributor to this disparity.

Conclusions: The survival disparity for Hispanic patients in SEER with HNSCC is explained by differences in presentation and treatment. Also, HPV tumor status is likely a key determinant of the disparity for black patients.

FIGURE 1

Kaplan–Meier estimate of disease-specific survival for all available white, Hispanic, and black patients. Unmatched analysis. Solid lines: probability of survival; dashed lines: 95% confidence interval, estimated by the log-transform method; vertical hashes: right censoring. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]

FIGURE 2

Kaplan–Meier estimate of disease-specific survival for case-matched cohorts. (A) Hispanic/White case matched pairs (n = 2609). (B) Black/White case matched pairs (n = 4671). Solid lines: probability of survival; dashed lines: 95% confidence interval, estimated by the log-transform method; vertical hashes: right censoring. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]

FIGURE 3

Kaplan–Meier estimate of disease-specific survival of head and neck squamous cell carcinoma (HNSCC) for case-matched cohorts, by race and subsite. (A) Hypopharynx. (B) Oral cavity. (C) Larynx. (D) Oropharynx. Solid lines: probability of survival; dashed lines: 95% confidence interval, estimated by the log-transform method; vertical hashes: right censoring. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]