title: Improved survival with HPV among African Americans with oropharyngeal cancer.
abstract: OBJECTIVE
  A major limitation of studies reporting a lower prevalence rate of human papilloma virus (HPV) in African American patients with oropharyngeal squamous cell cancer (OPSCC) than Caucasian Americans, with corresponding worse outcomes, was adequate representation of HPV-positive African American patients. This study examined survival outcomes in HPV-positive and HPV-negative African Americans with OPSCC.
  
  
  METHODS
  The study cohort of 121 patients with primary OPSCC had 42% African Americans. Variables of interest included age, race, gender, HPV status, stage, marital status, smoking, treatment, and date of diagnosis.
  
  
  RESULTS
  Caucasian Americans are more likely to be HPV positive (OR = 3.28; P = 0.035), as are younger age (age < 50 OR = 7.14; P = 0.023 compared with age > 65) or being married (OR = 3.44; P = 0.016). HPV positivity and being unmarried were associated with being late stage (OR = 3.10; P = 0.047 and OR = 3.23; P = 0.038, respectively). HPV-negative patients had 2.7 times the risk of death as HPV-positive patients (P = 0.004). Overall, the HPV-race groups differed (log-rank P < 0.001), with significantly worse survival for HPV-negative African Americans versus (i) HPV-positive African Americans (HR = 3.44; P = 0.0012); (ii) HPV-positive Caucasian Americans (HR = 3.11; P = < 0.049); and (iii) HPV-negative Caucasian Americans (HR = 2.21; P = 0.049).
  
  
  CONCLUSIONS
  HPV has a substantial impact on overall survival in African American patients with OPSCC. Among African American patients with OPSCC, HPV-positive patients had better survival than HPV negative. HPV-negative African Americans also did worse than both HPV-positive Caucasian Americans and HPV-negative Caucasian Americans. This study adds to the mounting evidence of HPV as a racially linked sexual behavior life style risk factor impacting survival outcomes for both African American and Caucasian American patients with OPSCC.
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: Kang Mei
authors.initials: KM
authors.lastname: Chen
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.forename: Vanessa
authors.initials: V
authors.lastname: Schweitzer
authors.forename: Shaleta
authors.initials: S
authors.lastname: Havard
authors.forename: George
authors.initials: G
authors.lastname: Divine
mesh_terms: D001741:Black or African American; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality* / Q000821:virology; D005260:Female; D052162:Human papillomavirus 16 / Q000235:genetics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009959:Oropharyngeal Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000821:virology; D030361:Papillomavirus Infections / Q000208:ethnology / Q000401:mortality* / Q000821:virology; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D044465:White People