An exploratory subgroup analysis of race and gender in squamous cancer of the head and neck: inferior outcomes for African American males in the LORHAN database

Abstract

Objectives: Previous retrospective analyses show poor outcomes for African American (AA) patients with head and neck carcinoma (HNC). Such racial disparities are not well understood, and generally studies have been too small to investigate subgroups and interactions related to race.

Materials and methods: The longitudinal oncology registry of head and neck carcinoma registry was used to identify patients ⩾18 years of age with squamous cell carcinoma of the head and neck, with no baseline metastases, and with an adequate record of survival time. Patient demographic and treatment characteristics were evaluated as a function of race and other known potential confounders of outcome. Associations between patient characteristics, including smoking, stage, performance status, and overall survival (OS) and progression-free survival (PFS) outcomes were also examined.

Results: Analysis of OS and PFS confirmed prior reports of inferior outcomes in AA patients vs. Whites with median OS/3-yr rate 41.7 mo/52% in AAs vs. 56.6 mo/70% in Whites (hazard ratio: 1.69 [95% confidence interval: 1.42, 2.01]). The elevated risk for worse OS and PFS in AAs remained, after multivariate adjustment. African American males incurred most of the excess risk compared to AA females.

Conclusion: This exploratory study confirmed a worse OS and PFS prognosis for AA patients, and it documents that most of the excess risk occurs in AA males. Future studies should confirm these findings and should investigate biological and other factors that account for such profound differences in outcomes.

Keywords: Carcinoma; Gender; Head; Head and neck cancer; Neck; Oral cancer; Race.