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Lower disease control rates and survival outcomes among Blacks with pharyngeal squamous cell carcinomas compared with Whites: a retrospective analysis at the University of Florida

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Abstract

Disparate clinical outcomes for pharyngeal squamous cell carcinoma (PSCC) of the oropharynx (OPSCC) and hypopharynx (HPSCC) have been observed in Black compared with White patients. Higher tobacco and alcohol use has been associated with decreased survival in Black patients with PSCC. Higher human papilloma virus (HPV) infection rates, associated with specific subsites of the oropharynx, are linked to improved overall survival (OS). Using an institutional cohort of Black and White patients with PSCC, we performed a retrospective analysis using multiple disease endpoints including local control (LC), local–regional control (LRC), freedom from distant metastases (DMFS), OS, cause-specific survival (CSS), and recorded tobacco and alcohol use. 1419 patients [Black (n = 111) and White (n = 1,308)] treated for PSCC from 1973 to 2013 were evaluated. PSCC 5- and 10-year LC, LRC, and DMFS and CSS rates were lower for Blacks. Notably, Black patients with OPSCC had higher stage cancers, higher percentage of soft palate tumors, and lower percentage of base of tongue cancers, were more likely to receive radiotherapy, and had higher tobacco and alcohol use. OS was significantly lower in Black patients at both anatomic sites, with the greatest difference observed for OPSCC. Multivariate analysis showed race and tobacco independently predicted DMFS, OS, and CSS; however, tobacco use had a greater impact on DMFS (HR 2.5, p = 0.021) than race (HR 1.9, p = 0.027). Overall, we propose that the higher burden of tobacco use along with a lower rate of tumors arising from traditional HPV-related subsites were important contributors to disparate disease outcomes seen in our Black patients.

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Author information

Author notes

  1. Alexander Parker and William M. Mendenhall are senior authors who contributed equally to this work.

Authors and Affiliations

  1. Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, 1600 SW Archer Rd., Gainesville, FL, 32610, USA

    Kristianna M. Fredenburg

  2. Division of Infectious Disease, University of Florida College of Medicine, Gainesville, USA

    Joan Whitlock

  3. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA

    Christopher Morris, Jessica Kirwan & William M. Mendenhall

  4. Department of Otolaryngology, University of Florida College of Medicine, Gainesville, USA

    Natalie L. Silver

  5. University of Florida College of Medicine-Jacksonville, Jacksonville, FL, 32209, USA

    Alexander Parker

  6. Department of Epidemiology & Biostatistics, College of Public Health, Temple University, Philadelphia, PA, 19111, USA

    Camille Ragin

Authors
  1. Kristianna M. Fredenburg
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  2. Joan Whitlock
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  3. Christopher Morris
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  4. Jessica Kirwan
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  5. Natalie L. Silver
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  6. Camille Ragin
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  7. Alexander Parker
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Correspondence to Kristianna M. Fredenburg.

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Fredenburg, K.M., Whitlock, J., Morris, C. et al. Lower disease control rates and survival outcomes among Blacks with pharyngeal squamous cell carcinomas compared with Whites: a retrospective analysis at the University of Florida. Cancer Causes Control 32, 1269–1278 (2021). https://doi.org/10.1007/s10552-021-01477-3

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  • DOI: https://doi.org/10.1007/s10552-021-01477-3

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