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Racial Survival Disparity in Head and Neck Cancer Results from Low Prevalence of Human Papillomavirus Infection in Black Oropharyngeal Cancer Patients

Authors' Affiliations: ¹ University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, Maryland; ² Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; and ³ sanofi-aventis, Bridgewater, New Jersey

Requests for reprints: Kevin J. Cullen, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Room N9E17, 22 South Greene Street, Baltimore, MD 21201. Phone: 410-328-5506; Fax: 410-328-8455; E-mail: kcullen{at}umm.edu.

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.

Commentary

Oropharyngeal Cancer, Race, and the Human Papillomavirus

Otis W. Brawley
Cancer Prevention Research 2009 2: 769-772. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				O. W. Brawley Oropharyngeal Cancer, Race, and the Human Papillomavirus Cancer Prevention Research, September 1, 2009; 2(9): 769 - 772. [Abstract] [Full Text] [PDF]