Human papillomavirus-active head and neck cancer and ethnic health disparities.
OBJECTIVE
Mortality for black males with head and neck squamous cell carcinoma (HNSCC) is twice that of white males or females. Human papillomavirus (HPV)-active HNSCC, defined by the concurrent presence of high-risk type HPV DNA and host cell p16(INK4a) expression, is associated with decreased mortality. We hypothesized that prevalence of this HPV-active disease class would be lower in black HNSCC patients compared to white patients.


METHODS
Multi-institutional retrospective cohort analysis.


METHODS
Real-time polymerase chain reaction was used to evaluate for high-risk HPV DNA presence. Immunohistochemistry for p16(INK4a) protein was used as a surrogate marker for HPV oncoprotein activity. Patients were classified as HPV-negative (HPV DNA-negative, p16(INK4a) low), HPV-inactive (HPV DNA-positive, p16(INK4a) low), and HPV-active (HPV DNA-positive, p16(INK4a) high). Overall survival and recurrence rates were compared by Fisher exact test and Kaplan-Meier analysis.


RESULTS
There were 140 patients with HNSCC who met inclusion criteria. Self-reported ethnicity was white (115), black (25), and other (0). Amplifiable DNA was recovered from 102/140 patients. The presence of HPV DNA and the level of p16(INK4a) expression were determined, and the results were used to classify these patients as HPV-negative (44), HPV-inactive (33), and HPV-active (25). Patients with HPV-active HNSCC had improved overall 5-year survival (59.7%) compared to HPV-negative and HPV-inactive patients (16.9%) (P = .003). Black patients were less likely to have HPV-active disease (0%) compared to white patients (21%) (P = .017).


CONCLUSIONS
The favorable HPV-active disease class is less common in black than in white patients with HNSCC, which appears to partially explain observed ethnic health disparities.
Weinberger
Paul M
PM
Department of Otolaryngology, Medical College of Georgia, Augusta, Georgia, USA.
Merkley
Mark A
MA
Khichi
Sunny S
SS
Lee
Jeffrey R
JR
Psyrri
Amanda
A
Jackson
Lana L
LL
Dynan
William S
WS
D000328:Adult; D001741:Black or African American; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae; D016019:Survival Analysis; D014412:Tumor Virus Infections / Q000453:epidemiology* / Q000821:virology; D014481:United States; D044465:White People