Introduction
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer in the United States with 65,410 new diagnoses in 2019.(1) Over the past three decades, HNSCC epidemiology has changed significantly due to the rapidly increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC).(2) This is primarily driven by rising exposure to the human papillomavirus (HPV) infection, which now accounts for 60-70% of incident OPSCC cases.(3) Compared to HPV-negative OPSCC, the demographic profile of patients with HPV-positive OPSCC tends to be younger, male, white, and non-smokers.(3) It is estimated that there are 3,500 new cases of HPV-associated OPSCC diagnosed in women and 15,500 in men each year in the United States.(4) In the United States, white patients with OPSCC are more likely than black patients to have HPV-positive tumors (67.6% vs. 42.3%, respectively; p<0.001).(5) Most studies evaluating the prognosis for patients with OPSCC have been composed of primarily of white patients. To date, there is limited information regarding the prognosis of black patients with HPV-associated OPSCC.
Racial disparities in HNSCC have been well described, but it is unknown if these findings translate to HPV-associated OPSCC, which is now recognized as a distinct clinicopathologic entity. Although black patients account for a minority of all HNSCC cases, they contribute disproportionately to the morbidity and mortality associated with this disease.(6,7) Black HNSCC patients are diagnosed at more advanced disease stage and have worse survival outcomes compared to white HNSCC patients.(8–10) Previous studies have suggested that lower socioeconomic status and differential access to care contribute to this disparity.(11,12) Some studies have shown that the racial disparities in HNSCC are largely driven by the OPSCC subsite, given that HPV-associated disease is more prevalent in white patients and has better prognosis.(13) However few studies have examined racial disparities in OPSCC while also assessing the relative influence of HPV-status.
A recent systematic review of studies assessing racial disparities in OS in OPSCC after adjusting for HPV-status (13) identified only 5 studies in the current literature that examined survival disparities by race after adjusting for HPV-status in OPSCC. None of these studies included measures of SES in the adjustment set. Furthermore, only one study included alcohol use in the adjustment set. These findings suggest that HPV-status accounts for much of the racial disparity in OS for OPSCC, but conclusions were limited by the small number of relevant studies and narrow adjustment sets.
To address this gap in current literature we examined racial differences in HPV-associated OPSCC outcomes using a population-based study with information on individual level-SES, as well as comprehensive demographic, clinical, and treatment variables. Previous studies examining racial disparities have relied either on single-institution data, clinical trial data, or cancer registry data, in which this information was not available.