Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by <scp>HPV</scp> status

Stein, Eva; Lenze, Nicholas R.; Yarbrough, Wendell G.; Hayes, D. Neil; Mazul, Angela L.; Sheth, Siddharth

doi:10.1002/hed.26328

Cited by 18 publications

(19 citation statements)

References 43 publications

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“…Another study of patients with sinonasal undifferentiated carcinoma reported significantly worse overall survival outcomes in patients with government insurance or low education 21 . Based on these findings, as well as findings from other studies reported in head and neck oncology literature, 22–24 it is plausible that low socioeconomic status might drive the racial disparity observed in our sample. A notable limitation of our retrospective analysis is that our dataset lacked information on household income, education, or insurance status.…”

Section: Discussionsupporting

confidence: 73%

Outcomes of Endoscopic Versus Open Skull Base Surgery in Pediatric Patients

et al. 2020

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Objective/Hypothesis To characterize the pathology and outcomes of skull base surgery in the pediatric population by open versus endoscopic surgical approach. Study Design Retrospective cohort study. Methods A retrospective review of pediatric patients (<18 years) who underwent skull base surgery for nonmalignant disease from May 2000 to August 2019 was performed. Patient demographics, pathology, and operative characteristics by surgical approach were recorded and analyzed. Patients with a combined endoscopic/open approach were classified as open for the analysis. Results Eighty‐two pediatric skull base patients were identified with a mean age of 11.3 years (standard deviation 5.2). A purely endoscopic approach was used in 63 (77%) patients, a purely open approach was used in nine (11%) patients, and a combined open/endoscopic approach was used in 10 (12%) patients. The all‐cause complication rate was 9.8%. There was no statistically significant difference in rate of complications between patients with an open versus endoscopic approach for resection (15.8% vs. 7.9%; P = .379). Risk of having a complication did not significantly vary by patient age. The odds of having a complication with an open approach was not statistically significant in a multivariable model adjusted for age, sex, race, intraoperative cerebrospinal fluid leak, tracheostomy requirement, and vascular flap use (odds ratio 2.76, 95% confidence interval 0.28–26.94; P = .383). Conclusions Our retrospective study demonstrates a similar risk of complication for open versus endoscopic approach to resection in pediatric skull base patients at our institution. Safety and feasibility of the endoscopic approach has previously been demonstrated in children, and this is the first study to directly compare outcomes with open approaches. Level of Evidence 4 Laryngoscope, 131:996–1001, 2021

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Section: Discussionsupporting

confidence: 73%

Outcomes of Endoscopic Versus Open Skull Base Surgery in Pediatric Patients

et al. 2020

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“…Guidelines have recommended that all OPC patients should be tested for HPV status and HPV-positive OPC was specified separately as an independent entity in the eighth edition of the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system (11)(12)(13). OPC patients with HPV positivity showed an improved response to therapy and a better survival (14,15). However, the role of HPV infection in non-oropharyngeal HNSCC of the nasopharynx, oral cavity, and hypopharynx was not well defined despite HPV infection being present in 7% to 25% of non-oropharyngeal HNSCC.…”

Section: Discussionmentioning

confidence: 99%

HPV Positive Status Is a Favorable Prognostic Factor in Non-Nasopharyngeal Head and Neck Squamous Cell Carcinoma Patients: A Retrospective Study From the Surveillance, Epidemiology, and End Results Database

Wang

Liu

et al. 2021

Front. Oncol.

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ObjectiveTo investigate the impact of the human papillomavirus (HPV) status on head and neck squamous cell carcinoma (HNSCC) arising from different anatomic subsites.MethodsHNSCC patients with known HPV status from the Surveillance, Epidemiology, and End Results (SEER) database between 2010–2015 were included in our analysis. Patients were classified into three categories of HNSCC according to Site recode ICD-O-3/WHO 2008 and Primary Site-labeled, namely, oropharynx, hypopharynx, and nasopharynx. Logistic regression model was conducted to evaluate the relationship between patient characteristics and HPV status. Kaplan-Meier methods and COX regression analysis were used to analyze survival data.ResultsA total of 9,943 HNSCC patients with known HPV status from the SEER database were enrolled, with 6,829 (68.7%) HPV-positive patients. HPV-positive and HPV-negative HNSCC were distinct and had different clinical and socioeconomic features (all P < 0.001). Primary sites, socioeconomical factors (age, sex, marital status, and race), and pathological features (TNM stage and grade) were closely related with HPV status (all P < 0.001). HPV-positive status was a favorable prognostic marker in HNSCC patients with cancers of the oropharynx and hypopharynx (all P < 0.001), but was not in nasopharyngeal carcinoma patients (P = 0.843). A total of 8,933 oropharyngeal carcinoma (OPC) and 558 hypopharyngeal carcinoma (HPC) patients were divided into the training and validation cohorts with a ratio of 1:1. Significant prognostic factors of the OS yielded by multivariate COX analysis in the training cohort were integrated to construct nomograms for OPC and HPC patients. The prognostic models showed a good discrimination with a C-index of 0.79 ± 0.007 and 0.73 ± 0.023 in OPC and HPC, respectively. Favorable calibration was reflected by the calibration curves. Additionally, corresponding risk classification systems for OPC and HPC patients based on the nomograms were built and could perfectly classify patients into low-risk, intermediated-risk, high-risk groups. OS in the three risk groups was accurately differentiated and showed a good discrimination.ConclusionHPV positivity was associated with an improved survival in HNSCC patients with cancers of the oropharynx and hypopharynx. Nomograms and corresponding risk classification systems were constructed to assist clinicians in evaluating the survival of OPC and HPC patients.

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“…Furthermore, black patients have worse survival outcomes, even after adjusting for disease stage (including untreatable disease), and treatment factors 12 . A recent meta‐analysis of survival disparities in squamous cell oropharyngeal cancer demonstrated a trend toward poorer survival in black patients with HPV‐negative tumors 13 . The mediators of the persistent racial disparities in oropharyngeal carcinoma are not well understood; however, further elucidation of these mediators can help identify actionable targets for interventions aimed at addressing disparities.…”

Section: Introductionmentioning

confidence: 99%

The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

Shukla

Megwalu

2021

Head & Neck

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Background To assess the role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes. Methods This was a population‐based retrospective cohort study. Data were extracted from the Surveillance, Epidemiology, and End Results 18 database. The study cohort included 11 627 patients diagnosed with oropharyngeal squamous cell carcinoma between 2010 and 2015. Results The association between black race and increased risk of unresectable disease was slightly attenuated, but persistent, after including insurance status as a covariate (odds ratio [OR] 1.34, 95%CI 1.10–1.63). Likewise, black race was no longer associated with worse disease‐specific survival (hazard ratio [HR] 1.11, 95%CI 0.99–1.26), but remained associated with worse overall survival with a slightly decreased effect size (HR 1.13, 95%CI 1.01–1.25). Conclusions Insurance status plays a significant role in, but does not completely account for, the persistent racial disparities in oropharyngeal cancer outcomes.

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Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by HPV status

Cited by 18 publications

References 43 publications

Outcomes of Endoscopic Versus Open Skull Base Surgery in Pediatric Patients

Outcomes of Endoscopic Versus Open Skull Base Surgery in Pediatric Patients

HPV Positive Status Is a Favorable Prognostic Factor in Non-Nasopharyngeal Head and Neck Squamous Cell Carcinoma Patients: A Retrospective Study From the Surveillance, Epidemiology, and End Results Database

The role of insurance status as a mediator of racial disparities in oropharyngeal cancer outcomes

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