Outcomes of HPV-Associated Squamous Cell Carcinoma of the Head and Neck: Impact of Race and Socioeconomic Status

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  • a Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts;
  • b Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina;
  • c Yale University School of Medicine, New Haven, Connecticut; and
  • d Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Background: Socioeconomic factors affecting outcomes of HPV-associated squamous cell carcinoma of the head and neck (SCCHN) are poorly characterized. Methods: A custom SEER database identified adult patients with primary nonmetastatic SCCHN and known HPV status diagnosed in 2013 through 2014. Multivariable logistic regression defined associations between patient characteristics and HPV status, with adjusted odds ratios (aORs) and 95% confidence intervals reported. Fine-Gray competing risks regression estimated adjusted hazard ratios (aHRs) and 95% confidence intervals for cancer-specific mortality (CSM), including a disease subsite * HPV status * race interaction term. Results: A total of 4,735 patients with nonmetastatic SCCHN and known HPV status were identified. HPV-associated SCCHN was positively associated with an oropharyngeal primary, male sex, and higher education, and negatively associated with uninsured status, single marital status, and nonwhite race (P≤.01 for all). For HPV-positive oropharyngeal SCCHN, white race was associated with lower CSM (aHR, 0.55; 95% CI, 0.34–0.88; P=.01) and uninsured status was associated with higher CSM (aHR, 3.12; 95% CI, 1.19–8.13; P=.02). These associations were not observed in HPV-negative or nonoropharynx SCCHN. Accordingly, there was a statistically significant disease subsite * HPV status * race interaction (P interaction<.001). Conclusions: Nonwhite race and uninsured status were associated with worse CSM in HPV-positive oropharyngeal SCCHN, whereas no such associations were observed in HPV-negative or nonoropharyngeal SCCHN. These results suggest that despite having clinically favorable disease, nonwhite patients with HPV-positive oropharyngeal SCCHN have worse outcomes than their white peers. Further work is needed to understand and reduce socioeconomic disparities in SCCHN.

Submitted February 18, 2019; accepted for publication September 3, 2019.

Author contributions: Study concept, data curation, and formal data analysis: Pike, B.A. Mahal, Sanford. Manuscript preparation–writing of original draft, review, and editing: All authors.

Disclosures: Dr. Pike has disclosed that he receives consulting fees from Third Rock Ventures. All remaining authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Luke R.G. Pike, MD, DPhil, Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. Email: lrpike@partners.org
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