title: Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients.
abstract: The burden of squamous cell carcinoma of the head and neck (SCCHN) is greater for blacks than for whites, especially in oropharyngeal cases. We previously showed retrospectively that disease-free survival was significantly greater in white than in black SCCHN patients treated with chemoradiation, the greatest difference occurring in the oropharyngeal subgroup. Oropharyngeal cancer is increasing in incidence and in its association with human papillomavirus (HPV) infection; HPV-positive oropharyngeal cancer patients have significantly better outcomes (versus HPV-negative). These collective data led to the present analyses of overall survival (OS) in our retrospective cohort and of OS and HPV status (tested prospectively in pretreatment biopsy specimens) in the phase 3, multicenter TAX 324 trial of induction chemotherapy followed by concurrent chemoradiation in SCCHN patients. Median OS in the retrospective cohort of 106 white and 95 black SCCHN patients was 52.1 months (white) versus only 23.7 months (black; P = 0.009), due entirely to OS in the subgroup of patients with oropharyngeal cancer--69.4 months (whites) versus 25.2 months (blacks; P = 0.0006); no significant difference by race occurred in survival of non-oropharyngeal SCCHN (P = 0.58). In TAX 324, 196 white patients and 28 black patients could be assessed for HPV status. Median OS was significantly worse for black patients (20.9 months) than for white patients (70.6 months; P = 0.03) and dramatically improved in HPV-positive (not reached) versus HPV-negative (26.6 months, 5.1 hazard ratio) oropharyngeal patients (P < 0.0001), 49% of whom were HPV-16 positive. Overall, HPV positivity was 34% in white versus 4% in black patients (P = 0.0004). Survival was similar for black and white HPV-negative patients (P = 0.56). This is the first prospective assessment of confirmed HPV status in black versus white SCCHN patients. Worse OS for black SCCHN patients was driven by oropharyngeal cancer outcomes, and that for black oropharyngeal cancer patients by a lower prevalence of HPV infection. These findings have important implications for the etiology, prevention, prognosis, and treatment of SCCHN.
authors.affiliation: University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD 21201, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Settle
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Posner
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Schumaker
authors.forename: Ming
authors.initials: M
authors.lastname: Tan
authors.forename: Mohan
authors.initials: M
authors.lastname: Suntharalingam
authors.forename: Olga
authors.initials: O
authors.lastname: Goloubeva
authors.forename: Scott E
authors.initials: SE
authors.lastname: Strome
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.forename: Shital S
authors.initials: SS
authors.lastname: Patel
authors.forename: Earl V
authors.initials: EV
authors.lastname: Cambell
authors.forename: Nicholas
authors.initials: N
authors.lastname: Sarlis
authors.forename: Jochen
authors.initials: J
authors.lastname: Lorch
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Cullen
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000628:therapy / Q000821:virology; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D052162:Human papillomavirus 16 / Q000235:genetics*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000628:therapy / Q000821:virology; D030361:Papillomavirus Infections / Q000401:mortality* / Q000628:therapy / Q000821:virology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
chemical_list: D004279:DNA, Viral