title: Patient and tumor factors at diagnosis in a multi-ethnic primary head and neck squamous cell carcinoma cohort.
abstract: BACKGROUND
  A long-term objective is to refine patient diagnosis and prognosis to address heterogeneity in head and neck squamous cell carcinoma (HNSCC) through incorporation of patient and tumor factors. This study examined histopathology and demographic variables at primary diagnosis (early vs. late stage) in a HNSCC patient population with a higher than usual percentage of African American (AA) subjects.
  
  
  METHODS
  The primary HNSCC cohort was drawn from a diverse patient population and constructed through re-review of the primary biopsy. Nine specific histopathology and patient factors (race, gender, age) at primary HNSCC diagnosis were evaluated. Logistic regression analyses incorporated univariate and multivariable modeling.
  
  
  RESULTS
  Race, gender, pattern of invasion, tumor necrosis, perineural invasion, site, and tumor grade were included in the first multivariable model. The final multivariable model retained gender, race, grade, site, and perineural invasion as independent risk factors for late stage with goodness-of-fit, the area under the curve (AUC), as 0.691.
  
  
  CONCLUSIONS
  This report emphasizes patient and tumor characteristics of race, gender, site, perineural invasion, grade, and pattern of invasion as independent factors of advanced stage HNSCC. Pattern of invasion and necrosis are also important tumor characteristics of late stage disease. These factors may offer clinical perspectives when evaluating patients with indeterminate stage.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Henry Ford Health Systems, Detroit, MI 48202, USA.
authors.forename: Seema
authors.initials: S
authors.lastname: Sethi
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Alissa
authors.initials: A
authors.lastname: Kapke
authors.forename: Michael S
authors.initials: MS
authors.lastname: Benninger
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Worsham
mesh_terms: D001741:Black or African American; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D014481:United States / Q000453:epidemiology; D044465:White People