Race impacts outcome in stage III/IV squamous cell carcinomas of the head and neck after concurrent chemoradiation therapy

Abstract

BACKGROUND:The purpose of this study was to determine the impact of race on outcome in patients with stage III/IV squamous cell carcinoma of the head and neck (SCCHN) who have completed concurrent chemoradiotherapy.METHODS:The authors performed a retrospective analysis of 202 patients with stage III/IV SCCHN who were treated at the University of Maryland. Patients received daily radiation to a total dose of 70.2 Gray (Gy) (1.8 Gy/day), concurrently with weekly carboplatin (area under the curve [AUC] = 2) and paclitaxel (45 mg/m2) chemotherapy.RESULTS:There were 108 Caucasian (CA) and 94 African American (AA) patients. The median age was 56 years, and 81% were stage IV. The median follow‐up was 33 months. The median overall survival (OS) and disease‐free survival (DFS) were 33 months and 19 months, respectively. When analyzed by race, the median DFS was 33 months (CA) versus 12 months (AA) (P = .028). The median OS was 44 months (CA) versus 24 months (AA) (P = .071). The 3‐year DFS for stage IV AA versus stage IV CA was 29% versus 50% (P = .031). The 3‐year DFS for N2 disease in AA versus CA was 32% versus 51% (P = .046). The 3‐year DFS for AA versus CA with oropharyngeal tumors was 30% versus 60% (P = .006).CONCLUSIONS:This analysis documents the inferior outcome for AA patients. They had inferior DFS and a trend toward worse OS. When stratified by several prognostic variables, the mediocre DFS in the AA patients remains. These data suggest that further investigation into the genetic characteristics of SCCHN in AA patients is warranted. Cancer 2009. © 2009 American Cancer Society.

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

“…From these patients, we selected a homogeneous cohort of white and black patients treated curatively with concurrent chemoradiotherapy for previously untreated SCCHN with no evidence of distant metastases. The strongest findings of our previously published and related retrospective analysis [based on a shorter median follow-up (versus the present analysis) of 33 months] involved disease-free survival (10). For the retrospective analysis presented here, we updated survival data with a focus on OS in all and oropharyngeal SCCHN patients and how OS may have differed by race.…”

“…Intensity of treatment was similar for the two groups and did not account for the differences in survival. In a previously reported retrospective analysis (10), we showed that disease-free survival was significantly greater in white than in black SCCHN patients who were treated with chemoradiation; the greatest black-white difference occurred in the oropharyngeal subgroup. We also recently analyzed race-related outcomes in two Radiation Therapy Oncology Group studies in head and neck cancer, finding in both studies that blacks had a significantly poorer outcome compared with whites, despite receiving identical treatment (11).…”

Impact of African–American race on presentation, treatment, and survival of head and neck cancer

“…Differences in socioeconomic status, biologic/genetic variation, and disproportionate exposure to alcohol and tobacco products are implicated as potential contributors to the excess incidence of HNC among African American patients [8,10,20,21]. Increasing oral health education has been suggested as a preventative approach to help reduce the environmental risks that African Americans are exposed to [22].…”

Prognostic factors for response to cisplatin-based chemotherapy in advanced cervical carcinoma: A Gynecologic Oncology Group Study

“…A worse outcome has been reported for African-American patients with breast cancer, 15 squamous cell cancers of the anus 16 and head and neck, 17 endometrial cancer, 18 and even for pediatric patients undergoing treatment for Hodgkin’s lymphoma. 19 In their analysis of 19,457 adult cancer patients treated on Southwest Oncology Group (SWOG) phase III trials, Albain and colleagues determined that African-American patients with early-stage premenopausal and postmenopausal breast cancer, advanced-stage ovarian cancer, and advanced-stage prostate cancer had increased mortality.…”