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. 2021 May;17(5):e695-e702.
doi: 10.1200/OP.20.01105.

African Americans With p16+ and p16- Oropharyngeal Squamous Cell Carcinomas Have Distinctly Poor Treatment Outcomes Independent of Medical Care Access

W Quinn O'Neill  1   2 , Jay Wasman  2   3 , Jason Thuener  1   2 , Kate Chatfield-Reed  2 , Lizabeth Lukesic  2 , Ravi Kyasram  2 , John Shanahan  2 , Blake Szelesety  1 , Brandon Vu  2 , Pierre Lavertu  1   2 , Rod Rezaee  1   2 , Shawn Li  1   2 , Nicole Fowler  1   2 , Theodoros N Teknos  1   2   4 , Quintin Pan  1   2   4
Affiliations

African Americans With p16+ and p16- Oropharyngeal Squamous Cell Carcinomas Have Distinctly Poor Treatment Outcomes Independent of Medical Care Access

W Quinn O'Neill et al. JCO Oncol Pract. 2021 May.

Abstract

Purpose: Human papilloma virus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), diagnosed with p16 immunohistochemistry, is associated with favorable prognosis; however, this connection was established using European American (EA)-skewed populations. The impact of p16/human papillomavirus status on outcomes in African American (AA) OPSCC patients remains to be settled. In this study, we determine the association between cancer disparity and p16 status in an OPSCC cohort controlling for time to treatment initiation (TTI), a surrogate for medical care access.

Materials and methods: We analyzed data from all patients diagnosed with OPSCC (N = 440) between 2010 and 2017, who received treatment at our academic medical center. Associations between age, disease stage, sex, p16 status, race, TTI, and overall survival (OS) were investigated.

Results: TTI was similar between AA and EA OPSCC patients in our p16+ (P = .291) or p16- (P = .715) cohorts. Among p16+ OPSCC patients, the median OS was > 8.65 years for EA patients compared with 5.038 years (95% CI, 2.019 to 5.30; P = .003, log-rank) for AA patients. For p16- patients, the median OS was 5.74 years (95% CI, 3.32 to 6.99) for EA patients and 1.85 years (95% CI, 0.978 to 4.50; P = .03, log-rank) for AA patients. Multivariate Cox regression analysis showed that race was an independent prognostic biomarker and the most impactful co-variate for OS (hazard ratio, 0.40; 95% CI, 0.00 to 0.69; P = .001).

Conclusion: Our work showed that AAs with p16+ OPSCC have surprisingly poor clinical outcomes and are thus poor candidates for treatment de-escalation regimens. Caution should be exercised when extending clinical guidelines based on EA-majority studies to non-EA populations.

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Conflict of interest statement

Rod RezaeeHonoraria: Zimmer BiometSpeakers' Bureau: Zimmer BiometPatents, Royalties, Other Intellectual Property: Zimmer/Biomet trauma fixation deviceTravel, Accommodations, Expenses: Zimmer BioMet Quintin PanResearch Funding: Bristol Myers Squibb FoundationPatents, Royalties, Other Intellectual Property: I have patents on p53 reactivation therapeutics for HPV+ HNSCCNo other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
TTI for AA and EA OPSCC patients: (A) p16+ cohort and (B) p16− cohort. For each cohort, comparisons are shown for all patients and for early-stage and late-stage patients separately. AA, African American; EA, European American; OPSCC, oropharyngeal squamous cell carcinoma; TTI, time to treatment initiation.
FIG 2.
FIG 2.
Kaplan-Meier curves for p16+ and p16− OPSCC patients. (A) Prognostic impact of race for p16+ and p16− OPSCC cohorts. (B) Prognostic impact of p16 status for EA and AA OPSCC patients. (C) Prognostic impact of race for early-stage and late-stage p16+ OPSCC patients. (D) Prognostic impact of race for early-stage and late-stage p16− OPSCC patients. AA, African American; EA, European American; OPSCC, oropharyngeal squamous cell carcinoma; OS, overall survival.
See this image and copyright information in PMC

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