Racial Disparities and HPV Status in Oropharyngeal Cancer

Presentation: AHNS035
Topic: Survivorship
Type: Oral
Date: Wednesday, April 18, 2018
Session: 3:40 PM - 4:40 PM Survivorship
Authors: Nicholas Lenze, BS1, Douglas R Farquhar, MD, MPH1, Angela L Mazul, PhD, MPH2, Maheer M Masood, BA1, Jose P Zevallos, MD, MPH3
Institution(s): 1Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, 2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis

Importance: There is lack of a consensus in current literature as to whether or not racial disparities in overall survival for black versus white Americans with oropharyngeal squamous cell carcinoma (OPSCC) persist after adjusting for human papillomavirus (HPV) status.

Objective: To use a meta-analysis to quantify the racial difference in black versus white Americans in overall survival for OPSCC after adjusting for HPV status.

Data Sources: PubMed/MEDLINE was searched through July 2017 and relevant article reference sections were reviewed for additional studies.

Study Selection: Systematic review was conducted for studies assessing overall survival in black versus white patients with OPSCC. Studies must have been written in English and conducted in the United States. Only cohort studies that had at least 50 patients and used a multivariate Cox regression to adjust for HPV status were included. Studies must have used an accepted method for measuring HPV status.

Data Extraction and Synthesis: Three review authors independently screened the articles for inclusion and two review authors independently extracted data from eligible studies. The PRISMA statement was followed. The pooled hazard ratio (HR) was calculated using a random-effects model.

Main Outcomes and Measures: The outcome of interest was overall survival. Overall survival was defined as the time from diagnosis or start of treatment to the date of death from any known cause or last known follow-up.  

Results: Seven studies met the inclusion criteria and had suitable data for pooling into the meta-analysis (N=1,342). The pooled HR for overall survival in black versus white Americans with OPSCC after adjusting for HPV status was calculated to be 1.45 (95% confidence interval, 1.02-2.05). Significant heterogeneity was found between the seven studies (I^2=56%, p=0.03), indicating the need for additional well-designed, large population studies.

Conclusions and Relevance: Racial disparities in overall survival for black versus white Americans with OPSCC persist after adjusting for HPV status. Future studies should continue to investigate the drivers of this disparity, and targeted public health efforts should be made to address them.