Nasopharynx Cancer in the United States: Racial and Ethnic Disparities in Stage at Presentation

Abstract

Introduction: Although nasopharynx cancer (NPC) is rare in the United States, global epidemiology varies greatly. Therefore, understanding NPC disparities in the diverse US setting is critical.

Methods and materials: Data from the National Cancer Database (NCDB, 2004-2021) identified patients with NPC; NCDB allows disaggregation by Asian American (AA) subgroups. Multivariable ordinal logistic regression adjusting for demographic and socioeconomic factors defined adjusted odds ratios (aORs).

Results: Of 15,862 patients, 11,173 (70.4%) were male (median age 59). Commonest groups included 10,034 (63.3%) White, 2,272 (14.3%) Black, 1,103 (7.0%) Chinese, 442 (2.8%) Filipino, and 338 (2.1%) Vietnamese patients. Prior to disaggregation, the proportion of stage IV disease at presentation was 43.2% among White (ref), 50.0% among Black (aOR 1.12, p = 0.012), 52.0% among Native American (aOR 1.18, p > 0.05), 41.9% among AA (aOR 0.97, p > 0.05), and 55.1% among Native Hawaiian and Other Pacific Islander patients (aOR 1.47, p = 0.021). Upon disaggregation, the proportion of stage IV disease was the greatest (>50%) among Black (50.0%, aOR 1.12, p = 0.012), Laotian (61.5%, aOR 2.21, p = 0.001), Hmong (73.2%, aOR 2.92, p < 0.001), and Other Pacific Islander patients (60.9%, aOR 1.83, p = 0.004); 44.2% of Filipino patients also presented with stage IV disease (aOR 1.21, p = 0.033). Odds of presenting with advanced stage disease were lower among Chinese patients (35.7% stage IV, aOR 0.72, p < 0.001).

Conclusions: Although most NPC patients were Chinese, White, or Black, stage IV disease at presentation was most common among Hmong, Laotian, non-Hawaiian Pacific Islander, and Black patients. Efforts are needed to improve awareness of NPC among less canonically affected groups.

Level of evidence: 4 Laryngoscope, 135:1113-1119, 2025.

Keywords: cancer disparities; head and neck cancer; health services; nasopharyngeal cancer; nasopharynx cancer; racial disparities.