Exploring racial disparities in oropharyngeal squamous cell carcinoma.

Abstract

e13813 Background: Oropharyngeal squamous cell carcinoma (OPSCC) demonstrates distinct survival outcomes based on its etiology: p16+ disease associated with HPV infection and p16- disease linked to carcinogen exposure. While HPV-related OPSCC is generally favorable, poorer survival outcomes have been observed in African American (AA) patients compared to European American (EA) patients. Methods: This retrospective study analyzed 214 OPSCC patients treated at a single institution (2012–2022). Demographics, TNM staging, treatment paradigms, and recurrence patterns were assessed. Patients were re-staged per AJCC 8th edition criteria. Results: Among the 214 patients, 79% were male, 45% were aged ≥65, 55% were EA, and 36% were AA. Reported alcohol (75%) and tobacco (77%) use were similar across groups however detailed analyses of pack year estimates were not available. p16+ disease was identified in 64%, p16- in 25%, and 11% were unknown. Nearly half of p16+ patients presented with stage 1 disease, while 57% of p16- patients had stage IV disease. In the p16+ cohort, AA patients presented with higher nodal staging (N3: 18% (6/34) vs. 6%, (5/87) p = 0.0262). No obvious presentation discrepancies were noted in p16- OPSCC. Recurrence was more frequent in p16- patients (31%vs 15% p = 0.0489), driven by higher locoregional recurrence (25%) which is well known. In p16+ OPSCC, AA patients had higher rates of never-disease-free status (13% (4/30) vs. 7% (5/73) patients) and locoregional recurrence (10% vs. 3%) compared to EA patients. In the p16- cohort, AA patients had more never-disease-free cases (35% (6/17) vs. 17%(3/18)), while EA patients had higher proportion of locoregional recurrence (33% vs. 18%). For stage 1 p16+ OPSCC, AA patients had worse overall survival (OS) compared to EA patients (median OS: 65 months vs. undefined; p = 0.0473, HR 4.039, 95% CI 0.727–22.44), despite similar radiation doses (AA: 6900 cGy vs. EA: 7000 cGy, p = 0.7412) and longer follow-up (63 vs. 39 months, p = 0.0799) highlighting at potential biological factors. Conclusions: AA patients with stage 1 p16+ OPSCC experience poorer OS despite comparable treatment (definitive radiation) likely driven clinically by higher persistent disease. This disparity may reflect a higher prevalence of OPSCC driven by combined HPV and carcinogen exposure in AA patients or some other yet fully characterized biological differences. Further research is needed to address these racial disparities.