Improved Survival with HPV among African Americans with Oropharyngeal Cancer

Abstract

Purpose A major limitation of studies reporting a lower prevalence rate of human papilloma virus (HPV) in African American (AA) oropharyngeal cancer (OPSCC) patients than Caucasian Americans (CA), with corresponding worse outcomes, was adequate representation of HPV positive AA patients. This study examined survival outcomes in HPV positive and HPV negative AA with OPSCC Experimental Design The study cohort of 121 primary OPSCC had 42% AA. Variables of interest included age, race, gender, HPV status, stage, marital status, smoking, treatment, and date of diagnosis. Results CA are more likely to be HPV positive (OR=3.28, p=0.035), as are younger age (age <50 OR=7.14, p=0.023 compared to age >65) or being married (OR=3.44, p= 0.016). HPV positivity and being unmarried were associated with being late stage (OR=3.10, p=0.047 and OR=3.23, p=0.038, respectively). HPV negative patients had 2.7 times the risk of death as HPV positive patients (p=0.004). Overall, the HPV-race groups differed (log-rank p<0.001), with significantly worse survival for HPV negative AA vs 1) HPV positive AA (HR=3.44, p=0.0012); 2) HPV positive CA (HR=3.11, p=<0.049); and 3) HPV negative CA (HR=2.21, p=0.049). Conclusions HPV has a substantial impact on overall survival in AA OPSCC. Among AA OPSCC, HPV positive patients had better survival than HPV negative. HPV negative AA also did worse than both, HPV positive CA and HPV negative CA. This study adds to the mounting evidence of HPV as a racially-linked sexual behavior life style risk factor impacting survival outcomes for both AA and CA OPSCC patients.

The Rise of HPV-Positive Oropharyngeal Cancers in the United States

“…Zandberg and colleagues present a survival analysis that was stratified by race and HPV tumor status. Consistent with previous reports (23,24), HPV-positive patients had improved survival as compared with HPV-negative patients after stratifying by race. However, when HPV-negative patients were stratified by race, there was a significant difference in overall survival.…”

“…In a recent survival analysis focusing on racial differences, blacks had significantly worse overall survival as compared with white patients with HPV-negative oropharyngeal cancer in a univariate analysis (24). However, race was not an independent marker for prognosis in multivariate models.…”

Prevalence of HPV infection in racial–ethnic subgroups of head and neck cancer patients

“…In the United States (US), a clear disparity in HNC survival has been reported between Black and White patients, particularly for oropharyngeal cancers. Poor survival rates for Black Americans compared to White Americans have been observed (7), and some studies have suggested that this disparity may be explained at least partially by a difference in prevalence of HPV infection (8)(9)(10).…”

HPV positive oropharyngeal cancer: risky sexual behavior

“…In our research we identify 15 articles focused on HPV associated oropharyngeal cancer and sexual behavior as a risk factor 1,3,9,[11][12][13][14][15][16][17][18][19][20][21][22] . One article studied the knowledge of HPV and its association with oropharyngeal cancer in a high-risk population 16 .…”

“…HPV related oropharyngeal squamous cell carcinomas have been showing a better prognosis if compared with those related to tobacco and alcoholism 9,10 . This fact makes stratification necessary for studies involving oropharyngeal squamous cell carcinomas.…”