title: African Americans with oropharyngeal carcinoma have significantly poorer outcomes despite similar rates of human papillomavirus-mediated carcinogenesis.
abstract: We examined racial disparities among 102 oropharyngeal carcinoma (OPC) patients (30 African Americans and 72 whites) comparing rates of transcriptionally active human papillomavirus (HPV)16/18 and p16(INK4a) overexpression, with times to disease progression and disease-specific survival (DSS). Expression of HPV16/18 transcripts was assessed by reverse transcription and polymerase chain reaction using type-specific E6/E7 primers; p16(INK4a) was evaluated by immunohistochemistry. African Americans were significantly more likely to present with high T stage disease and receive nonsurgical treatment. HPV16/18 was present in 63% of patients; no racial differences were observed. Silenced p16(INK4a) in OPC was significantly more common in African Americans (15/24) than in whites (20/69) (P = .004) and in HPV16+ African Americans (6/24) than in HPV+ whites (2/42) (P = .023). Kaplan-Meier analysis for DSS revealed a protective effect for p16(INK4a) overexpression (P = .0028; hazard ratio [HR], 0.23), HPV16+ (P = .036; HR, 0.38), and whites (P = .0039; HR, 0.27). Shorter DSS was associated with primary definitive chemoradiation (P = .019; HR, 3.49) and T3/T4 disease (P = .0001; HR, 7.75). A protective effect with respect to disease progression was observed for HPV16+ (P = .007; HR, 0.27), whites (P = .0006; HR, 0.197), and p16(INK4a) overexpression (P = .0001; HR, 0.116). African Americans with OPC experience poorer outcomes likely due to p16(INK4a) silencing, higher T stage, and nonsurgical treatment but not lower rates of transcriptionally active HPV16/18.
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Isayeva
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: Jie
authors.initials: J
authors.lastname: Xu
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: Qian
authors.initials: Q
authors.lastname: Dai
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Whitley
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: James
authors.initials: J
authors.lastname: Bonner
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: Lisle
authors.initials: L
authors.lastname: Nabell
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: Sharon
authors.initials: S
authors.lastname: Spencer
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331.
authors.forename: William
authors.initials: W
authors.lastname: Carroll
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Heath, Philadelphia, PA, 19111-2497.
authors.forename: Giera
authors.initials: G
authors.lastname: Jones
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Heath, Philadelphia, PA, 19111-2497.
authors.forename: Camille
authors.initials: C
authors.lastname: Ragin
authors.affiliation: Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 35249-7331. Electronic address: MGensler@UAB.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Brandwein-Gensler
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D063646:Carcinogenesis; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000096:biosynthesis; D005260:Female; D020868:Gene Silencing; D052162:Human papillomavirus 16 / Q000235:genetics; D052161:Human papillomavirus 18 / Q000235:genetics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000208:ethnology / Q000235:genetics / Q000401:mortality* / Q000628:therapy; D027383:Papillomaviridae / Q000378:metabolism; D030361:Papillomavirus Infections / Q000150:complications
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16
keywords: African Americans; Disparity; HPV; Oropharyngeal; Oropharynx; Outcome; p16