Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients.
Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients.
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DOI：
10.1158/1940-6207.capr-09-0149
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
Cullen KJ
中科院分区：
文献类型：
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作者：
Settle K;Posner MR;Schumaker LM;Tan M;Suntharalingam M;Goloubeva O;Strome SE;Haddad RI;Patel SS;Cambell EV 3rd;Sarlis N;Lorch J;Cullen KJ
头颈部鳞状细胞癌（SCCHN）的负担黑人大于白人，特别是在口咽病例。我们之前的回顾性研究显示，接受放化疗的白色SCCHN患者的无病生存率显著高于黑色SCCHN患者，其中最大的差异发生在口咽亚组。口咽癌的发病率及其与人乳头瘤病毒（HPV）感染的关系正在增加；hpv阳性口咽癌患者的预后明显更好（与hpv阴性患者相比）。这些数据使得我们对回顾性队列的总生存期（OS）和3期多中心TAX 324试验中SCCHN患者诱导化疗后同步放化疗的OS和HPV状态（在预处理活检标本中前瞻性测试）进行了分析。106名白人和95名黑人SCCHN患者的回顾性队列的中位生存期为52.1个月（白人），而黑人仅为23.7个月（P = 0.009），这完全是由于口咽癌患者亚组的生存期(69.4个月（白人）对25.2个月（黑人，P = 0.0006）；非口咽部SCCHN的生存率无种族差异（P = 0.58）。在tax324中，196名白人患者和28名黑人患者可以评估HPV状态。黑人患者的中位OS（20.9个月）明显差于白人患者（70.6个月，P = 0.03）， hpv阳性（未达到）口咽患者（26.6个月，5.1风险比）的中位OS显著改善（P < 0.0001），其中49%为HPV-16阳性。总体而言，HPV阳性在白人患者中为34%，在黑人患者中为4% （P = 0.0004）。黑人和白人hpv阴性患者的生存率相似（P = 0.56）。这是首次对黑人和白人SCCHN患者中确认的HPV状态进行前瞻性评估。黑人SCCHN患者较差的OS是由口咽癌结局驱动的，而黑人口咽癌患者的OS是由HPV感染的较低患病率驱动的。这些发现对SCCHN的病因、预防、预后和治疗具有重要意义。
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.