title: Disparate molecular, histopathology, and clinical factors in head and neck squamous cell carcinoma racial groups.
abstract: OBJECTIVE
  There is a lack of consensus regarding the causes of the differences in the higher incidence of and the mortality from head and neck squamous cell carcinoma (HNSCC) in African Americans (AA) versus Caucasian Americans (CA). We examined a comprehensive array of risk factors influencing health and disease in an access-to-care, racially diverse, primary HNSCC cohort.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Primary care academic health care system.
  
  
  METHODS
  The cohort of 673 patients comprised 391 CA and 282 AA (42%). Risk variables included demographic, histopathology, and clinical/epidemiologic factors. Tumor DNA was interrogated for loss and gain of 113 genes with known involvement in HNSCC/cancer. Logistic regression for univariate analysis was followed by multivariate modeling with determination of model predictability (c-index).
  
  
  RESULTS
  Of the 39 univariate differences between AA and CA, multivariate modeling (c-index = 0.81) retained 7 differences (P < .05). AA were less likely to be married and more likely to have tumor lymphocytic response, undergo radiation treatment, and smoke. Insurance type was a significant predictor of race. AA were more likely to have Medicaid, Medicare, and other HMO types. AA tumors were more likely to have loss of CDKN2A and gain of SCYA3 versus CA.
  
  
  CONCLUSIONS
  Multivariate modeling indicated significant differences between AA and CA HNSCC for histopathology, treatment, smoking, marital status, type of insurance, and tumor gene copy number alterations. Our data reiterate that for HNSCC, as in the case of other complex diseases, tumor genetics or biology is only one of many potential contributors to differences among racial groups.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. mworsha1@hfhs.org
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Worsham
authors.forename: Josena K
authors.initials: JK
authors.lastname: Stephen
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Kang Mei
authors.initials: KM
authors.lastname: Chen
authors.forename: Shaleta
authors.initials: S
authors.lastname: Havard
authors.forename: Veena
authors.initials: V
authors.lastname: Shah
authors.forename: Vanessa P
authors.initials: VP
authors.lastname: Schweitzer
mesh_terms: D001741:Black or African American; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000235:genetics* / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000235:genetics* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044465:White People