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Original Article
February 21, 2011

Human Papillomavirus–Related Squamous Cell Carcinoma of the Oropharynx: A Comparative Study in Whites and African Americans

Author Affiliations

Author Affiliations: Departments of Pathology and Immunology (Drs Chernock, El-Mofty, and Lewis) and Radiation Oncology (Dr Thorstad), and Division of Biostatistics (Ms Zhang), Washington University School of Medicine, St Louis, Missouri.

Arch Otolaryngol Head Neck Surg. 2011;137(2):163-169. doi:10.1001/archoto.2010.246

Objectives  To evaluate the frequency of human papillomavirus–related oropharyngeal squamous cell carcinoma in African Americans and whites and to examine patient outcomes in these 2 groups.

Design  Retrospective study.

Setting  One tertiary care, university medical center.

Patients  Information on patients with stage III/IV oropharyngeal squamous cell carcinoma diagnosed between 1998 and 2007, and with primary surgical samples available for review, were selected from a radiotherapy database. One patient was Native American and was excluded from analysis; data on 174 patients were analyzed.

Results  One hundred forty-eight patients (85.1%) were white and 26 (14.9%) were African American. Human papillomavirus in situ hybridization–positive and p16-positive tumors were much more common in whites (63.5% and 83.1% of tumors, respectively) than in African Americans (11.5% and 34.6% of tumors, respectively) (P < .001). African Americans were also more likely to have received definitive (nonsurgical) rather than postoperative radiation therapy (P = .001) and had a higher frequency of T3/T4–stage tumors (P = .03) compared with whites. Disease-free survival was significantly shorter for African Americans (P = .02). In multivariate analysis, viral status (P = .006), T stage (P = .02), and treatment type (P = .002), but not race (P = .98), were significant factors contributing to disease-free survival.

Conclusions  In high-stage oropharyngeal squamous cell carcinoma, the proportion of human papillomavirus–related tumors is much higher in whites than in African Americans. African Americans also appear to develop higher T-stage tumors and are more likely to receive definitive therapy. The shorter disease-free survival observed in African Americans may be due to viral status, treatment type, and higher T stage, but does not appear to be due to race.