Gender and race interact to influence survival disparities in head and neck cancer
Gender and race interact to influence survival disparities in head and neck cancer
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DOI：
10.1016/j.oraloncology.2020.105093
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发表时间：
2021-01-01
期刊：
影响因子：
4.8
通讯作者：
Puram, Sidharth, V
中科院分区：
文献类型：
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作者：
Mazul, Angela L.;Naik, Akash N.;Puram, Sidharth, V
头颈部鳞状细胞癌（HSNCC）生存率的性别和种族差异是独立的，但没有先前的研究已经检查了这些因素对HSNCC结局的联合影响。我们的目的是全面评估性别和种族对HNSCC总生存率的影响。我们从国家癌症数据库中构建了一个回顾性队列，用于2010年至2015年喉，下咽，口腔和口咽的原发性HNSCC。我们使用Kaplan-Meier曲线和考克斯比例风险回归计算校正治疗类型、年龄、保险、分期分类和合并症的风险比。与其他部位相比，西班牙裔和白色女性的口腔癌明显更常见。女性非口咽HNSCC病例的五年总生存率高于男性（分别为56.3%和54.4%），但黑人女性（52.8%）的生存率低于白色（56.2%）和西班牙裔（57.9%）男性。口咽癌的HPV状态有显着差异。值得注意的是，患有HPV阳性口咽OPSCC的黑人女性的生存率远远低于任何其他种族和性别群体。即使调整了潜在的中介因素，这些结果仍然存在。显然，性别是HNSCC的一个重要指标，并与种族有意义的相互作用。不同性别和种族的不同部位分布揭示了女性HNSCC的重要见解。考虑到这些性别差异，同时考虑到种族是至关重要的头部和颈部患者提供适当的照顾，并准确地咨询这些人的预后和结果。
Gender and race disparities in head and neck squamous cell carcinoma (HSNCC) survival are independently well documented, but no prior studies have examined the joint effect of these factors on HSNCC outcomes. We aim to comprehensively estimate the effect of gender and race on overall survival in HNSCC. We constructed a retrospective cohort from the National Cancer Database for primary HNSCC of the larynx, hypopharynx, oral cavity, and oropharynx from 2010 to 2015. We used Kaplan-Meier curves and Cox proportional hazards regressions to calculate hazard ratios adjusting for treatment type, age, insurance, staging classifications, and comorbidities. Oral cavity cancer was significantly more common among Hispanic and White females compared to other sites. Female non-oropharyngeal HNSCC cases had better five-year overall survival than males (56.3% versus 54.4%, respectively), though Black females (52.8%) had poorer survival than both White (56.2%) and Hispanic (57.9%) males. There were significant differences in oropharyngeal cancer by HPV status. Notably, Black females with HPV-positive oropharyngeal OPSCC had far worse survival than any other race and gender group. These results persisted even when adjusting for potential mediating factors. Clearly gender is a significant prognosticator for HNSCC and has meaningful interactions with race. The distinct site distributions across gender and race reveal important insights into HNSCC among females. Taking into account these gender disparities while considering race is essential to providing appropriate care to head and neck patients and accurately counselling these individuals on prognosis and outcomes.